Healthcare Provider Details

I. General information

NPI: 1952962391
Provider Name (Legal Business Name): NICOLE ANN ALANIZ AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

IV. Provider business mailing address

4256 LYRA CT
LAS CRUCES NM
88011-0946
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-6740
  • Fax:
Mailing address:
  • Phone: 575-642-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN-72848
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number57103
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: