Healthcare Provider Details

I. General information

NPI: 1982003158
Provider Name (Legal Business Name): BIANCA MEZA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BIANCA MEDINA

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 MONTGOMERY BLVD NE STE 1A
ALBUQUERQUE NM
87111-3664
US

IV. Provider business mailing address

1606 VALLE VISTA RD NW
LOS LUNAS NM
87031-8916
US

V. Phone/Fax

Practice location:
  • Phone: 505-855-9267
  • Fax:
Mailing address:
  • Phone: 505-433-0631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-72297
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number73290
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: