Individual
KATELAN MARIE WENGERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
28 BACA RD, CUBERO, NM 87014-0106
(505) 290-9213
Mailing address
28 BACA RD, CUBERO, NM 87014-0106
(505) 290-9213
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
60445
NM
Other
Enumeration date
03/10/2023
Last updated
03/10/2023
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