Individual
MS. PROVIDENCE MUSOMANDERA BOTNE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
2600 MARBLE, ALBUQUERQUE, NM 87151-0001
(505) 839-8839
(505) 839-8989
Mailing address
10712 CENTRAL PARK DR NE, ALBUQUERQUE, NM 87123-4849
(505) 292-4144
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
R53622
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R53622
R.N.LICENCE
NM
Enumeration date
11/08/2005
Last updated
07/08/2007
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