Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | CNP-03004 | NM |
NPI | 1538612353 |
---|---|
Provider Name | Jennifer Vergeer |
First Address | Albuquerque, NM 87109-6748 |
Second Address | Albuquerque, NM 87109-4495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2016 |
Last Update Date | 15/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64689077 | (05) | NM |