Healthcare Provider Details

I. General information

NPI: 1831488139
Provider Name (Legal Business Name): ANDREA NICOLE VASQUEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W THOMAS RD
PHOENIX AZ
85013-4409
US

IV. Provider business mailing address

1241 W MINERAL AVE SUITE 100
LITTLETON CO
80120-5685
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-3000
  • Fax: 602-406-7165
Mailing address:
  • Phone: 303-759-0854
  • Fax: 303-759-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4021
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: