Provider Demographics
NPI:1407170426
Name:DELGRANDE, ANGELA LISA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LISA
Last Name:DELGRANDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8609 AZTEC RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4505
Mailing Address - Country:US
Mailing Address - Phone:505-294-4483
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN PEDRO DRIVE SE
Practice Address - Street 2:NEW MEXICO VA HEALTH CARE SYSTEM
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-265-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01652363LP0808X
NMCNS00090364SP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP1700XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerinatal