Healthcare Provider Details

I. General information

NPI: 1003699125
Provider Name (Legal Business Name): MELISSA KOLKENA CNM, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 MONTGOMERY BLVD NE STE 301
ALBUQUERQUE NM
87109-1234
US

IV. Provider business mailing address

4705 MONTGOMERY BLVD NE STE 301
ALBUQUERQUE NM
87109-1234
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7800
  • Fax:
Mailing address:
  • Phone: 505-727-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number863
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: