Healthcare Provider Details

I. General information

NPI: 1891784088
Provider Name (Legal Business Name): VASPRO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 ACADEMY RD NE SUITE 340
ALBUQUERQUE NM
87111-1229
US

IV. Provider business mailing address

10400 ACADEMY RD NE SUITE 340
ALBUQUERQUE NM
87111-1229
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-1558
  • Fax: 505-298-7012
Mailing address:
  • Phone: 505-298-1558
  • Fax: 505-298-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR25188
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR19106
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR31749
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN130480
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN086525
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR18198
License Number StateNM

VIII. Authorized Official

Name: MR. KENNETH G ABBOTT
Title or Position: PRESIDENT / CEO
Credential:
Phone: 505-298-1558