Provider Demographics
NPI:1215368048
Name:VEDENEEVA, ELENA (CNP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:VEDENEEVA
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 1:465 SAINT MICHAELS DR STE 209
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-8603
Mailing Address - Country:US
Mailing Address - Phone:505-913-3933
Mailing Address - Fax:
Practice Address - Street 1:465 SAINT MICHAELS DR STE 209
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-8603
Practice Address - Country:US
Practice Address - Phone:505-913-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02298363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care