Provider Demographics
NPI:1437774312
Name:VIGIL, MAISIE (NSW)
Entity Type:Individual
Prefix:
First Name:MAISIE
Middle Name:
Last Name:VIGIL
Suffix:
Gender:F
Credentials:NSW
Other - Prefix:
Other - First Name:MAISIE
Other - Middle Name:
Other - Last Name:DEUEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 E BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NM
Mailing Address - Zip Code:87413-6235
Mailing Address - Country:US
Mailing Address - Phone:505-947-4384
Mailing Address - Fax:505-234-7867
Practice Address - Street 1:101 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-6235
Practice Address - Country:US
Practice Address - Phone:505-947-4384
Practice Address - Fax:505-234-7867
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker