MEDICARE: SHANA D VAZQUEZ RN

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	163W00000X	Registered Nurse	1114997	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VADOO	OTHER		UPIN

General Provider Information

NPI Number	:	1285966507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANA D VAZQUEZ RN

Provider Business Mailing Address
First Line	:	13677 GLEN VISTA LN
Second Line	:
City	:	HORIZON CITY
State	:	TX
Zip	:	79928-6082
Country	:	US
Telephone Number	:	808-778-3901
Fax Number	:

Provider Business Practice Location Address
First Line	:	21227 TORCH ST
Second Line	:
City	:	FT BLISS
State	:	TX
Zip	:	79918
Country	:	US
Telephone Number	:	915-742-9232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2010
Last Update Date	:	11/22/2024

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