Provider Demographics
NPI:1982003158
Name:MEZA, BIANCA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:MEZA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1606 VALLE VISTA RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8916
Mailing Address - Country:US
Mailing Address - Phone:505-433-0631
Mailing Address - Fax:
Practice Address - Street 1:10151 MONTGOMERY BLVD NE STE 1A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3664
Practice Address - Country:US
Practice Address - Phone:505-855-9267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-72297163W00000X
NM73290363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse