MEDICARE: MRS. ANA LUISA VASQUEZ-KISHBAUGH RN, BSN

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	163WG0000X	General Practice Registered Nurse	RN30189	NM

General Provider Information

NPI Number	:	1982734612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANA LUISA VASQUEZ-KISHBAUGH RN, BSN

Provider Business Mailing Address
First Line	:	33 HOT SPRINGS CANYON RD
Second Line	:
City	:	SAN LORENZO
State	:	NM
Zip	:	88041
Country	:	US
Telephone Number	:	505-536-3302
Fax Number	:	505-537-5503

Provider Business Practice Location Address
First Line	:	900 CENTRAL
Second Line	:
City	:	BAYARD
State	:	NM
Zip	:	88023
Country	:	US
Telephone Number	:	505-537-4000
Fax Number	:	505-537-5503

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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