Healthcare Provider Details

I. General information

NPI: 1164483962
Provider Name (Legal Business Name): KAREN C O'DAY CNM, CFNP, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 5TH ST SUITE 101
SANTA FE NM
87505-5403
US

IV. Provider business mailing address

1911 5TH ST SUITE 101
SANTA FE NM
87505-5403
US

V. Phone/Fax

Practice location:
  • Phone: 505-780-8301
  • Fax: 505-780-5418
Mailing address:
  • Phone: 505-780-8301
  • Fax: 505-780-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR25968
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number462
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: