Doctor Name: | MRS. KATHLYN MARIE EYDENBERG |
NPI Number: | 1134284730 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, MSN, CPNP |
License Number: | R45087 |
Business Practice Address: | Mescalero Phs Indian Hospital Mescalero, NM - 88340 |
Business Phone Number: | 5054644441 |
Business Fax Number: | |
Mailing Address: | 3209 10th St, ALAMOGORDO |
State: | NM |
Postal Code: | 883104106 |
Phone Number: | 5054340146 |
Fax Number: | |
NPI Enumeration Date: | 12/26/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | R45087 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |