Healthcare Provider Details

I. General information

NPI: 1134203334
Provider Name (Legal Business Name): KAREN DEGENEVIEVE CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN DEGENEVIEVE MSN, CFNP

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E 32ND ST
SILVER CITY NM
88061-7251
US

IV. Provider business mailing address

1313 E 32ND ST
SILVER CITY NM
88061-7251
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-4009
  • Fax: 575-538-4003
Mailing address:
  • Phone: 575-538-4009
  • Fax: 575-538-4003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR28079
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: