Healthcare Provider Details

I. General information

NPI: 1407170426
Provider Name (Legal Business Name): ANGELA LISA DELGRANDE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 08/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DRIVE SE NEW MEXICO VA HEALTH CARE SYSTEM
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

8609 AZTEC RD NE
ALBUQUERQUE NM
87111-4505
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-294-4483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-01652
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code364SP1700X
TaxonomyPerinatal Clinical Nurse Specialist
License NumberCNS00090
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: