Provider Demographics
NPI:1861540148
Name:DIABETES NETWORK, INC.
Entity type:Organization
Organization Name:DIABETES NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, CFO, COO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, BC-ADM, CDE
Authorized Official - Phone:505-830-0100
Mailing Address - Street 1:4108 ALCAZAR ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1809
Mailing Address - Country:US
Mailing Address - Phone:505-830-0100
Mailing Address - Fax:505-830-4199
Practice Address - Street 1:4108 ALCAZAR ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1809
Practice Address - Country:US
Practice Address - Phone:505-830-0100
Practice Address - Fax:505-830-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR79BOtherBCBS PROVIDER NUM
NMDA7203Medicare ID - Type UnspecifiedMEDICARE-RAILROAD GRP NUM