Healthcare Provider Details

I. General information

NPI: 1679208052
Provider Name (Legal Business Name): KATE ELIZABETH NELSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 ALTO ST
SANTA FE NM
87501-2406
US

IV. Provider business mailing address

1464 MIRACERROS LOOP N
SANTA FE NM
87505-4022
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-3217
  • Fax:
Mailing address:
  • Phone: 505-231-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69040
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: