Healthcare Provider Details

I. General information

NPI: 1346576352
Provider Name (Legal Business Name): MARIA VANESSA MENANTEAU CNM, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 CALLE DE ALEGRA BLDG C
LAS CRUCES NM
88005-3423
US

IV. Provider business mailing address

385 CALLE DE ALEGRA BLDG. A
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-8200
  • Fax: 575-521-7199
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number54521
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR 192328-3
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number697
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: