Healthcare Provider Details

I. General information

NPI: 1316184831
Provider Name (Legal Business Name): MONIQUE Y KEULEN-NOLET FNP RN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIQUE Y LOPEZ-NOLET RN

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 03/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12127B NORTH HIGHWAY 14 SUITE #5
CEDAR CREST NM
87008
US

IV. Provider business mailing address

44 EL CIELO AZUL CIR
EDGEWOOD NM
87015-7916
US

V. Phone/Fax

Practice location:
  • Phone: 505-281-2460
  • Fax: 505-281-2463
Mailing address:
  • Phone: 505-281-8493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 34614
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: