Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN-72148 | NM |
NPI | 1043857410 |
---|---|
Provider Name | Elizabeth F Baca |
First Address | Albuquerque, NM 87123-4439 |
Second Address | Albuquerque, NM 87131-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2019 |
Last Update Date | 15/09/2020 |