Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APRN-CNP57838 | NM |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 95001139 | CA |
NPI | 1043610488 |
---|---|
Provider Name | Mrs. Lea Rotenberg Koshkin |
First Address | Albuquerque, NM 87125-6028 |
Second Address | Albuquerque, NM 87109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2014 |
Last Update Date | 02/10/2019 |