Healthcare Provider Details

I. General information

NPI: 1154143386
Provider Name (Legal Business Name): VANESSA SENA CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 MONTGOMERY BLVD NE STE 201
ALBUQUERQUE NM
87111-2467
US

IV. Provider business mailing address

4933 CALLE DE CARINO NE
ALBUQUERQUE NM
87111-2962
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-2505
  • Fax:
Mailing address:
  • Phone: 505-382-6343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number81485
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: