Healthcare Provider Details

I. General information

NPI: 1811072846
Provider Name (Legal Business Name): KATHERINE JANET CARPENTER DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 NICOLE PL
SANTA FE NM
87505-0705
US

IV. Provider business mailing address

913 NICOLE PL
SANTA FE NM
87505-0705
US

V. Phone/Fax

Practice location:
  • Phone: 505-992-3393
  • Fax: 505-992-3393
Mailing address:
  • Phone: 505-992-3393
  • Fax: 505-992-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number875
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: