Healthcare Provider Details

I. General information

NPI: 1114060092
Provider Name (Legal Business Name): CHRISTENE VANCOTT CNM CFNP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 HILLRISE DR BLDG 2 UNIT A
LAS CRUCES NM
88011-4701
US

IV. Provider business mailing address

PO BOX 1560
LAS CRUCES NM
88004-1560
US

V. Phone/Fax

Practice location:
  • Phone: 505-532-6061
  • Fax: 505-532-6063
Mailing address:
  • Phone: 505-647-8366
  • Fax: 505-647-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR33894
License Number StateNM

VIII. Authorized Official

Name: PEARIE K BRUDER
Title or Position: BUSINESS DEVELOPMENT DIRECTOR
Credential:
Phone: 505-647-8366