Provider Demographics
NPI:1346576352
Name:MENANTEAU, MARIA VANESSA (CNM, FNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VANESSA
Last Name:MENANTEAU
Suffix:
Gender:F
Credentials:CNM, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 CALLE DE ALEGRA
Mailing Address - Street 2:BLDG. A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3423
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:385 CALLE DE ALEGRA BLDG C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3423
Practice Address - Country:US
Practice Address - Phone:575-556-8200
Practice Address - Fax:575-521-7199
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54521363LF0000X
MNR 192328-3367A00000X
NM697367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM419259YPD8OtherMEDICARE
NM75482711Medicaid