Provider Demographics
NPI:1821661810
Name:DUBA, KATHERINE ANN (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:DUBA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 SANDIA CREST RD
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-2413
Mailing Address - Country:US
Mailing Address - Phone:618-671-8963
Mailing Address - Fax:
Practice Address - Street 1:5900 FOREST HILLS DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4129
Practice Address - Country:US
Practice Address - Phone:619-671-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021019692363LA2200X
NM67996363LA2200X, 363LG0600X
IL209023478363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health