Individual
KIMBERLEY B. OLDEWAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1350 JACKIE ROAD STE 101, WESTSIDE FAMILY MEDICINE, RIO RANCHO, NM 87124-1519
(505) 892-7518
(505) 892-9092
Mailing address
1350 JACKIE ROAD STE 101, WESTSIDE FAMILY MEDICINE, RIO RANCHO, NM 87124-1519
(505) 892-7518
(505) 892-9092
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2011-0041
NM
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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