Healthcare Provider Details

I. General information

NPI: 1609897388
Provider Name (Legal Business Name): KATHIE SUE MAXWELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 405
ALBUQUERQUE NM
87106-4924
US

IV. Provider business mailing address

201 CEDAR ST SE STE 405
ALBUQUERQUE NM
87106-4924
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-9535
  • Fax: 505-924-7336
Mailing address:
  • Phone: 505-764-9535
  • Fax: 505-924-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number547
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: