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General NPI Number Information
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NPI Number | 1730192840
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERANS AFFAIRS
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1501 SAN PEDRO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5153
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Country | US
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Telephone | 505-265-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 6 APPLEWOOD LN NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-6404
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Country | US
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Telephone | 505-898-2543
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Fax |
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Authorized Official
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Title or Position | NURSE MANAGER
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Name | MRS. ELAINE LOUISE BAWDEN
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Credential | CNS
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Telephone | 505-265-1711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | R24940
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License Number State | NM
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