Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | R48516 | NM |
NPI | 1184669368 |
---|---|
Provider Name | Vanessa V Casarez |
First Address | Albuquerque, NM 87109-3587 |
Second Address | Albuquerque, NM 87106-4930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (02) | NM |
PENDING | (05) | NM |