Most Relevant Information
Provider Data
| NPI Number: | 1003183187 |
| Provider Name: | KIMBERLEY B. OLDEWAGE PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA2011-0041 |
Most Important Dates
| Enumeration Date: | 11/17/2011 |
| Last Updated: | 11/17/2011 |
Provider Practice Location
1350 JACKIE ROAD STE 101
WESTSIDE FAMILY MEDICINE
RIO RANCHO
NM
871241519
Practice Location Phone/Fax
| Phone: | 5058927518 |
| Fax: | 5058929092 |
Provider Mailing Location
1350 JACKIE ROAD STE 101
WESTSIDE FAMILY MEDICINE
RIO RANCHO
NM
871241519
Provider Mailing Phone/Fax
| Phone: | 5058927518 |
| Fax: | 5058929092 |