Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | CNP02787 | NM |
NPI | 1003255639 |
---|---|
Provider Name | Mrs. Nicole Ann Badillo |
First Address | Albuquerque, NM 87108 |
Second Address | Albuquerque, NM 87109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2013 |
Last Update Date | 18/12/2015 |