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General NPI Number Information
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NPI Number | 1821661810
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Entity Type | Individual
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Provider Name | KATHERINE ANN DUBA NP
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Gender | Female
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 03/18/2023
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Provider Practice Location Address
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Address Line | 5900 FOREST HILLS DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4129
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Country | US
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Telephone | 619-671-8963
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Fax |
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Provider Business Mailing Address
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Address Line | 78 SANDIA CREST RD
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City | SANDIA PARK
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State | NM
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Zip | 87047-2413
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Country | US
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Telephone | 618-671-8963
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2021019692
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 67996
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209023478
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 67996
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License Number State | NM
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