Healthcare Provider Details

I. General information

NPI: 1144455031
Provider Name (Legal Business Name): PAMELA P VIGIL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 TURQUOISE AVE NE
ALBUQUERQUE NM
87123-2068
US

IV. Provider business mailing address

13420 TURQUOISE AVE NE
ALBUQUERQUE NM
87123-2068
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-7068
  • Fax:
Mailing address:
  • Phone: 505-323-7068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01491
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: