=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982954293
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE RULE CRC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2012
-----------------------------------------------------
Last Update Date | 09/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 936 DUNLAP ST
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87501-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-626-6850
-----------------------------------------------------
Fax | 413-517-0567
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 936 DUNLAP ST
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87501-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-626-6850
-----------------------------------------------------
Fax | 413-517-0567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number | 00043481
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------