Healthcare Provider Details

I. General information

NPI: 1902214273
Provider Name (Legal Business Name): KATHERINE DEUTSCH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2405
US

IV. Provider business mailing address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-4288
  • Fax: 505-275-4201
Mailing address:
  • Phone: 505-262-7960
  • Fax: 505-232-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02482
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: