Healthcare Provider Details

I. General information

NPI: 1174007561
Provider Name (Legal Business Name): NADIA L CANO VAZQUEZ CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E SPRUCE ST STE 1
DEMING NM
88030-3865
US

IV. Provider business mailing address

800 E SPRUCE ST STE 1
DEMING NM
88030-3865
US

V. Phone/Fax

Practice location:
  • Phone: 575-936-4207
  • Fax: 575-936-4077
Mailing address:
  • Phone: 575-936-4207
  • Fax: 575-936-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number250792
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53843
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: