Healthcare Provider Details

I. General information

NPI: 1942632765
Provider Name (Legal Business Name): KATHERINE CHOE RAVER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 09/20/2020
Certification Date: 09/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 OSUNA RD NE STE 5C
ALBUQUERQUE NM
87111-2072
US

IV. Provider business mailing address

8400 OSUNA RD NE STE 5C
ALBUQUERQUE NM
87111-2072
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-2345
  • Fax: 505-800-5030
Mailing address:
  • Phone: 505-585-2345
  • Fax: 505-800-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03063
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: