Healthcare Provider Details

I. General information

NPI: 1124144944
Provider Name (Legal Business Name): LOUISE B KAHN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC 09 5350
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

MSC 09 5350
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6061
  • Fax: 505-272-8901
Mailing address:
  • Phone: 505-272-6061
  • Fax: 505-272-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR18448
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: