Provider Demographics
NPI:1801048525
Name:WHITCOMB, KATHRYN D (DOM)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:D
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 CAMINO LADO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5440
Mailing Address - Country:US
Mailing Address - Phone:505-473-3855
Mailing Address - Fax:
Practice Address - Street 1:2053 CAMINO LADO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5440
Practice Address - Country:US
Practice Address - Phone:505-473-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM779171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist