Healthcare Provider Details

I. General information

NPI: 1467672543
Provider Name (Legal Business Name): KATHLEEN M WEIDNER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 HOSPITAL DR SOUTHWESTERN EAR NOSE & THROAT PA
SANTA FE NM
87505-4743
US

IV. Provider business mailing address

1620 HOSPITAL DR SOUTHWESTERN EAR NOSE & THROAT PA
SANTA FE NM
87505-4743
US

V. Phone/Fax

Practice location:
  • Phone: 505-946-3907
  • Fax:
Mailing address:
  • Phone: 505-946-3907
  • Fax: 505-984-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberNM2623
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: