Healthcare Provider Details

I. General information

NPI: 1376259747
Provider Name (Legal Business Name): PATRICIA DIANE OLGUIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 LAGRIMA DE ORO RD NE
ALBUQUERQUE NM
87111-3737
US

IV. Provider business mailing address

8604 BOUVARDIA AVE NW
ALBUQUERQUE NM
87120-4270
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-4001
  • Fax:
Mailing address:
  • Phone: 505-307-4506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71703
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: