Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 323 | NM |
Y | 363L00000X | Nurse Practitioner | RN704177 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | R33894 | NM |
NPI | 1124130224 |
---|---|
Provider Name | Christene Vancott |
First Address | Las Cruces, NM 88011-9338 |
Second Address | San Diego, CA 92102-4541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86454757 | (05) | NM |
S42814 | (02) |