Healthcare Provider Details

I. General information

NPI: 1700951803
Provider Name (Legal Business Name): ELIZABETH KIRCHER-RAITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 SAN MATEO BLVD NE SUITE #305
ALBUQUERQUE NM
87110-1921
US

IV. Provider business mailing address

3167 SAN MATEO BLVD NE SUITE #305
ALBUQUERQUE NM
87110-1921
US

V. Phone/Fax

Practice location:
  • Phone: 505-286-0654
  • Fax: 505-281-3022
Mailing address:
  • Phone: 505-286-0654
  • Fax: 505-281-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number00F449
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: