Healthcare Provider Details

I. General information

NPI: 1740469642
Provider Name (Legal Business Name): KATHERINE KOIKE PATTERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE ROSE KOIKE RN

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

3205 CINIZA DR
GALLUP NM
87301-4618
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax: 505-722-1310
Mailing address:
  • Phone: 505-722-1756
  • Fax: 505-722-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR17335
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: