Healthcare Provider Details

I. General information

NPI: 1437795432
Provider Name (Legal Business Name): COLLEEN N FELDEWERT AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BECKNER RD
SANTA FE NM
87507-3774
US

IV. Provider business mailing address

18 PASEO DEL CABALLO E
SANTA FE NM
87508
US

V. Phone/Fax

Practice location:
  • Phone: 505-477-2200
  • Fax:
Mailing address:
  • Phone: 505-690-6829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD6915
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: