=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174007561
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NADIA L CANO VAZQUEZ CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2018
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 E SPRUCE ST STE 1
-----------------------------------------------------
City | DEMING
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88030-3865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-936-4207
-----------------------------------------------------
Fax | 575-936-4077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 E SPRUCE ST STE 1
-----------------------------------------------------
City | DEMING
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88030-3865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-936-4207
-----------------------------------------------------
Fax | 575-936-4077
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 250792
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 53843
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------