Healthcare Provider Details

I. General information

NPI: 1992591176
Provider Name (Legal Business Name): MONIQUE DANIELLE COOLIDGE MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6341 RIVERSIDE PLAZA LN NW STE A-1
ALBUQUERQUE NM
87120-2646
US

IV. Provider business mailing address

6341 RIVERSIDE PLAZA LN NW STE A-1
ALBUQUERQUE NM
87120-2646
US

V. Phone/Fax

Practice location:
  • Phone: 505-207-6526
  • Fax: 505-212-1615
Mailing address:
  • Phone: 505-207-6526
  • Fax: 505-212-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77960
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: