Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | C-09658 | NM |
N | 207QA0401X | Family Doctor - Addiction Medicine | C-09658 | NM |
N | 207QA0505X | Family Doctor - Adult Medicine | C-09658 | NM |
N | 208000000X | Pediatrician | C-09658 | NM |
N | 2080N0001X | Neonatal-Perinatal Doctor | C-09658 | NM |
N | 2080P0006X | Developmental - Behavioral Pediatrician | C-09658 | NM |
NPI | 1891266458 |
---|---|
Provider Name | Karen Ann Longenecker |
First Address | Albuquerque, NM 87107-1851 |
Second Address | Albuquerque, NM 87107-1851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2018 |
Last Update Date | 07/12/2018 |