Provider Demographics
NPI:1174007561
Name:CANO VAZQUEZ, NADIA L (CNP)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:L
Last Name:CANO VAZQUEZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8427 E BASELINE RD
Mailing Address - Street 2:STE 104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-4381
Mailing Address - Country:US
Mailing Address - Phone:505-925-7897
Mailing Address - Fax:505-925-7849
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-925-7897
Practice Address - Fax:505-925-7849
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53843363L00000X
AZ250792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner