Healthcare Provider Details

I. General information

NPI: 1205637071
Provider Name (Legal Business Name): SELENA VICTORIA MENAPACE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4934
US

IV. Provider business mailing address

7720 KENTWOOD AVE NW
ALBUQUERQUE NM
87114-4164
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1090
  • Fax:
Mailing address:
  • Phone: 505-728-2763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number57658
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number57658
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: