Provider Demographics
NPI:1720610868
Name:ZAMORA, VICKIE DIANE (RN)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:DIANE
Last Name:ZAMORA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:DIANE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-1300
Mailing Address - Country:US
Mailing Address - Phone:505-565-8755
Mailing Address - Fax:505-565-8762
Practice Address - Street 1:310 BONITA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-565-8755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR54686163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool