MEDICARE: MS. KATIJANE CROWE DEXTER CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	60952	NM
2	207VX0201X	Gynecologic Oncology Physician	60952	NM

General Provider Information

NPI Number	:	1275142648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATIJANE CROWE DEXTER CNP

Provider Business Mailing Address
First Line	:	800 BRADBURY DR SE STE 116
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4310
Country	:	US
Telephone Number	:	505-272-1476
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 SILVER AVE SE APT B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4051
Country	:	US
Telephone Number	:	505-917-1022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2020
Last Update Date	:	02/12/2025

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