1467534289 NPI number — MRS. CATHERINE MARY ELLIOTT RDH

Table of content: MRS. CATHERINE MARY ELLIOTT RDH (NPI 1467534289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467534289 NPI number — MRS. CATHERINE MARY ELLIOTT RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
CATHERINE
Provider Middle Name:
MARY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOLFINGTON
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467534289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8104 CEDAR CREEK DR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87120-3844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-615-0951
Provider Business Mailing Address Fax Number:
505-792-6737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8104 CEDAR CREEK DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87120-3844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-615-0951
Provider Business Practice Location Address Fax Number:
505-792-6737
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  DH228 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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