=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366323610
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIVIANA NUNEZ LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2025
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27TH SPECIAL OPERATIONS MEDICAL GROUP
-----------------------------------------------------
City | CANNON AFB
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-784-2778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 224 W D. L. INGRA
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88101-8529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 80831
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------