Basic Information
| Provider Information | |||||||||
| NPI: | 1598205528 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | KATHARINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, MSN, WHNP-BC | ||||||||
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| OtherLastName: | WHEELWRIGHT | ||||||||
| OtherFirstName: | KATHARINE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 933 BRADBURY DR SE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064374 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1231 CANDELARIA RD NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052722158 | ||||||||
| FaxNumber: | 5052728053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2017 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN-84082 | NM | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN2279657 | MA | N | Nursing Service Providers | Registered Nurse | 163W00000X | R217057 | MD | N | Nursing Service Providers | Registered Nurse | 363LW0102X | CNP-03163 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.