MEDICARE: GRACIE ORDORICA

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	363LN0005X	Critical Care Neonatal Nurse Practitioner	CNP00598	NM

General Provider Information

NPI Number	:	1295797363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACIE ORDORICA

Provider Business Mailing Address
First Line	:	4604 MESA CENTRAL DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-7270
Country	:	US
Telephone Number	:	575-649-0514
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8255
Country	:	US
Telephone Number	:	575-556-6915
Fax Number	:	575-556-6919

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	11/20/2022

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Directions to “ GRACIE ORDORICA ” Practice Location

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