Provider Demographics
NPI:1114060092
Name:CHRISTENE VANCOTT CNM CFNP PC
Entity Type:Organization
Organization Name:CHRISTENE VANCOTT CNM CFNP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DEVELOPMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PEARIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BRUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-647-8366
Mailing Address - Street 1:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1560
Mailing Address - Country:US
Mailing Address - Phone:505-647-8366
Mailing Address - Fax:505-647-8381
Practice Address - Street 1:2905 HILLRISE DR
Practice Address - Street 2:BLDG 2 UNIT A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4701
Practice Address - Country:US
Practice Address - Phone:505-532-6061
Practice Address - Fax:505-532-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR33894163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty