Healthcare Provider Details

I. General information

NPI: 1003148156
Provider Name (Legal Business Name): MAUREEN KOLOMEIR RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2010
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 WYOMING BLVD SUITE 101
ALBUQUERQUE NM
87109-3193
US

IV. Provider business mailing address

8205 SPAIN RD NE SUITE 106
ALBUQUERQUE NM
87109-3155
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-6898
  • Fax: 505-292-1574
Mailing address:
  • Phone: 505-384-7352
  • Fax: 505-274-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-01573
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: