Healthcare Provider Details

I. General information

NPI: 1356607303
Provider Name (Legal Business Name): KATHARINE ELIZABETH DANNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHARINE ELIZABETH MCSHAN

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 10/18/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 BECKNER ROAD
SANTA FE NM
87507-3691
US

IV. Provider business mailing address

4730 BECKNER ROAD
SANTA FE NM
87507-3691
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-4500
  • Fax: 505-443-8313
Mailing address:
  • Phone: 505-989-4500
  • Fax: 505-443-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2016-0662
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60772054
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0066046
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: