MEDICARE: MS. VICKI VENTURA MSN,CNS,APRN,BC

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	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	CNS0069	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629172333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI VENTURA MSN,CNS,APRN,BC

Provider Business Mailing Address
First Line	:	4608 GRETTA COURT NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3715
Country	:	US
Telephone Number	:	505-452-2286
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 LANG AVENUE NE
Second Line	:	SUITE 110
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4407
Country	:	US
Telephone Number	:	505-798-2633
Fax Number	:	505-796-9801

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	02/19/2013

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