Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 60952 | NM |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 60952 | NM |
NPI | 1275142648 |
---|---|
Provider Name | Ms. Katijane Crowe Dexter |
First Address | Albuquerque, NM 87102-4517 |
Second Address | Albuquerque, NM 87106-4051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2020 |
Last Update Date | 04/11/2020 |