Provider Demographics
NPI:1760566038
Name:BACA, JANET GALE (CRNFA RN BSN CNOR)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:GALE
Last Name:BACA
Suffix:
Gender:F
Credentials:CRNFA RN BSN CNOR
Other - Prefix:MISS
Other - First Name:JANET
Other - Middle Name:GALE
Other - Last Name:NIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1311 CAMINO ECUESTRE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-2612
Mailing Address - Country:US
Mailing Address - Phone:505-345-4647
Mailing Address - Fax:505-345-3127
Practice Address - Street 1:1311 CAMINO ECUESTRE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-2612
Practice Address - Country:US
Practice Address - Phone:505-345-4647
Practice Address - Fax:505-345-3127
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR18882163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR79ZOtherBLUE CROSS BLUE SHIELD
NM3474983OtherCIGNA HEALTHCARE
NM0007286391OtherAETNA