Healthcare Provider Details

I. General information

NPI: 1972577328
Provider Name (Legal Business Name): ELIZABETH D PATERSON ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1382
US

IV. Provider business mailing address

303 SAN MATEO BLVD NE STE 104
ALBUQUERQUE NM
87108-1382
US

V. Phone/Fax

Practice location:
  • Phone: 505-808-2870
  • Fax: 505-322-2709
Mailing address:
  • Phone: 505-808-2870
  • Fax: 505-322-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number167585
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP-01653
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: