Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | A-2173-18 | NM |
NPI | 1477935047 |
---|---|
Provider Name | Katherine Nixon |
First Address | Pueblo, CO 81003-2745 |
Second Address | Las Cruces, NM 88011-8255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2015 |
Last Update Date | 09/10/2020 |