Healthcare Provider Details

I. General information

NPI: 1184687923
Provider Name (Legal Business Name): CYNTHIA M. GRIEGO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO SE VAMC - SCI UNIT
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

13900 NAMBE AVE NE
ALBUQUERQUE NM
87123-4746
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR 19376
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: