Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CNP-01573 | NM |
NPI | 1003148156 |
---|---|
Provider Name | Ms. Maureen Kolomeir |
First Address | Albuquerque, NM 87109-3155 |
Second Address | Albuquerque, NM 87109-3193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2010 |
Last Update Date | 28/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
84887231 | (05) | NM |