Healthcare Provider Details

I. General information

NPI: 1598282485
Provider Name (Legal Business Name): KRISTEN OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST STE H2
SANTA FE NM
87505-2106
US

IV. Provider business mailing address

2019 GALISTEO ST STE H2
SANTA FE NM
87505-2106
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-6140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8610
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: