Provider Demographics
NPI:1609285535
Name:VAZQUEZ, CARMEN MARIA (RN, FNP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:MARIA
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12075 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:WI
Mailing Address - Zip Code:54412-9562
Mailing Address - Country:US
Mailing Address - Phone:715-570-4667
Mailing Address - Fax:
Practice Address - Street 1:12075 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:WI
Practice Address - Zip Code:54412-9562
Practice Address - Country:US
Practice Address - Phone:715-570-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12196-33363L00000X
WI171798-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner