Healthcare Provider Details

I. General information

NPI: 1881979680
Provider Name (Legal Business Name): JANETTE KATHERINE KOTTONG MSN, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 ALAMEDA PARK DR NE
ALBUQUERQUE NM
87113-2475
US

IV. Provider business mailing address

8725 ALAMEDA PARK DR NE
ALBUQUERQUE NM
87113-2475
US

V. Phone/Fax

Practice location:
  • Phone: 505-331-8481
  • Fax:
Mailing address:
  • Phone: 505-828-0232
  • Fax: 505-823-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01866
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: