Provider Demographics
NPI:1083358857
Name:MORA, VANESSA MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MARIE
Last Name:MORA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:MARIE
Other - Last Name:TAFOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6621 ORPHELIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3752
Mailing Address - Country:US
Mailing Address - Phone:505-290-2101
Mailing Address - Fax:
Practice Address - Street 1:6621 ORPHELIA AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3752
Practice Address - Country:US
Practice Address - Phone:505-290-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM67456363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health