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General NPI Number Information
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NPI Number | 1700393766
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Entity Type | Individual
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Provider Name | STACY JAQUE VIGIL
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Gender | Female
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 213 CHICO DR
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City | LAS VEGAS
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State | NM
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Zip | 87701-9511
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Country | US
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Telephone | 505-429-5508
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Fax |
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Provider Business Mailing Address
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Address Line | 1264 RODEO RD
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City | SANTA FE
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State | NM
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Zip | 87505-6816
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Country | US
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Telephone | 505-982-2129
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | LPN-22383
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN-22383
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License Number State | NM
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