Provider Demographics
NPI: | 1942632765 |
---|---|
Name: | RAVER, KATHERINE CHOE (FNP-C) |
Entity Type: | Individual |
Prefix: | |
First Name: | KATHERINE |
Middle Name: | CHOE |
Last Name: | RAVER |
Suffix: | |
Gender: | F |
Credentials: | FNP-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 8400 OSUNA RD NE STE 5C |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBUQUERQUE |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87111-2072 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 505-585-2345 |
Mailing Address - Fax: | 505-800-5030 |
Practice Address - Street 1: | 8400 OSUNA RD NE STE 5C |
Practice Address - Street 2: | |
Practice Address - City: | ALBUQUERQUE |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87111-2072 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-585-2345 |
Practice Address - Fax: | 505-800-5030 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2013-08-02 |
Last Update Date: | 2020-09-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NM | CNP-03063 | 363LF0000X |
TX | 2476 | 363LF0000X |
TX | AP124143 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NM | CNP-03063 | Other | APRN LICENSE |
TX | 852925 | Other | TX LICENSE |
TX | 852925 | Other | TX LICENSE |