Healthcare Provider Details

I. General information

NPI: 1730002528
Provider Name (Legal Business Name): MARIAN KATHERINE BROTHERTON MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIAN KATHERINE GABALDON

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 8TH ST
LAS VEGAS NM
87701-4219
US

IV. Provider business mailing address

3314 LUNA DR
LAS VEGAS NM
87701-9733
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-6788
  • Fax:
Mailing address:
  • Phone: 505-429-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number64366
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: