Healthcare Provider Details

I. General information

NPI: 1417661869
Provider Name (Legal Business Name): ERICA NICOLE VANARSDALE MPH, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date: 02/27/2023
Reactivation Date: 03/07/2023

III. Provider practice location address

1216 4TH ST NW
ALBUQUERQUE NM
87102-1415
US

IV. Provider business mailing address

1201 3RD ST NW
ALBUQUERQUE NM
87102-1403
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-8231
  • Fax: 505-248-1351
Mailing address:
  • Phone: 505-764-8231
  • Fax: 505-248-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69789
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: