Healthcare Provider Details

I. General information

NPI: 1861540148
Provider Name (Legal Business Name): DIABETES NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 ALCAZAR ST NE
ALBUQUERQUE NM
87109-1809
US

IV. Provider business mailing address

4108 ALCAZAR ST NE
ALBUQUERQUE NM
87109-1809
US

V. Phone/Fax

Practice location:
  • Phone: 505-830-0100
  • Fax: 505-830-4199
Mailing address:
  • Phone: 505-830-0100
  • Fax: 505-830-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE ANNE GRAY
Title or Position: CO-OWNER, CFO, COO
Credential: CNS, BC-ADM, CDE
Phone: 505-830-0100