Provider Demographics
NPI:1417679317
Name:NEMITZ, KATELYNN NICOLE
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:NICOLE
Last Name:NEMITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 CAGUA DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3717
Mailing Address - Country:US
Mailing Address - Phone:505-553-3161
Mailing Address - Fax:
Practice Address - Street 1:713 CAGUA DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3717
Practice Address - Country:US
Practice Address - Phone:505-553-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A