Healthcare Provider Details

I. General information

NPI: 1326712662
Provider Name (Legal Business Name): VANESSA NICOLE ROMERO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648B ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

IV. Provider business mailing address

926 HOLLYWOOD BLVD
CORRALES NM
87048-8478
US

V. Phone/Fax

Practice location:
  • Phone: 505-966-9644
  • Fax: 505-212-5792
Mailing address:
  • Phone: 505-269-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number64433
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: