Provider Demographics
NPI:1851320592
Name:ANDERSON, MARY KATHERINE (FNP)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 QUINCY ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3512
Mailing Address - Country:US
Mailing Address - Phone:505-239-1758
Mailing Address - Fax:
Practice Address - Street 1:UNM COLLEGE OF NURSING
Practice Address - Street 2:MSC 09 5350
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-3984
Practice Address - Fax:505-272-8901
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCNP-01754OtherNEW MEXICO APN #
NMCNP-01754OtherNEW MEXICO APN #