Healthcare Provider Details

I. General information

NPI: 1235193822
Provider Name (Legal Business Name): KATHLEEN WARNER AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE AUDIOLOGY SECTION (126)
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

1501 SAN PEDRO DR SE AUDIOLOGY SECTION (126)
ALBUQUERQUE NM
87108-5153
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-2733
  • Fax:
Mailing address:
  • Phone: 505-256-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1844
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: