MEDICARE: CHRISTENE VANCOTT CNM CFNP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	R33894	NM

General Provider Information

NPI Number	:	1114060092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTENE VANCOTT CNM CFNP PC

Provider Business Mailing Address
First Line	:	PO BOX 1560
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88004-1560
Country	:	US
Telephone Number	:	505-647-8366
Fax Number	:	505-647-8381

Provider Business Practice Location Address
First Line	:	2905 HILLRISE DR
Second Line	:	BLDG 2 UNIT A
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4701
Country	:	US
Telephone Number	:	505-532-6061
Fax Number	:	505-532-6063

Authorized Official
Title or Position	:	BUSINESS DEVELOPMENT DIRECTOR
Name	:	PEARIE K BRUDER
Credential	:
Telephone Number	:	505-647-8366

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	08/22/2020

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