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General NPI Number Information
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NPI Number | 1285966507
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Entity Type | Individual
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Provider Name | SHANA D VAZQUEZ RN
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Gender | Female
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Dates
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Enumeration Date | 02/11/2010
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 21227 TORCH ST
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City | FT BLISS
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State | TX
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Zip | 79918
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Country | US
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Telephone | 915-742-9232
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Fax |
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Provider Business Mailing Address
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Address Line | 13677 GLEN VISTA LN
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City | HORIZON CITY
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State | TX
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Zip | 79928-6082
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Country | US
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Telephone | 808-778-3901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1114997
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License Number State | TX
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