Healthcare Provider Details

I. General information

NPI: 1124130224
Provider Name (Legal Business Name): CHRISTENE VANCOTT CNM CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 BATAAN MEMORIAL E
LAS CRUCES NM
88011-6016
US

IV. Provider business mailing address

9745 HARDROCK RD
LAS CRUCES NM
88011-9338
US

V. Phone/Fax

Practice location:
  • Phone: 575-373-9202
  • Fax: 575-373-9592
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number323
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN704177
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP00702
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: