Healthcare Provider Details

I. General information

NPI: 1750189635
Provider Name (Legal Business Name): KATLIN MAGI CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 QUAIL RUN DR NE
ALBUQUERQUE NM
87122-1141
US

IV. Provider business mailing address

1919 QUAIL RUN DR NE
ALBUQUERQUE NM
87122-1141
US

V. Phone/Fax

Practice location:
  • Phone: 505-720-6645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number82491
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: