Provider Demographics
NPI:1326712662
Name:ROMERO, VANESSA NICOLE (FNP)
Entity Type:Individual
Prefix:PROF
First Name:VANESSA
Middle Name:NICOLE
Last Name:ROMERO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8478
Mailing Address - Country:US
Mailing Address - Phone:505-269-3149
Mailing Address - Fax:
Practice Address - Street 1:1648B ALAMEDA BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-8807
Practice Address - Country:US
Practice Address - Phone:505-966-9644
Practice Address - Fax:505-212-5792
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM64433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty