Provider Demographics
NPI:1750089678
Name:BACHICHA, ILANA LUCIA (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:LUCIA
Last Name:BACHICHA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:ILANA
Other - Middle Name:LUCIA
Other - Last Name:SAIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN-FNP-BC
Mailing Address - Street 1:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:RIBERA
Mailing Address - State:NM
Mailing Address - Zip Code:87560-0627
Mailing Address - Country:US
Mailing Address - Phone:505-603-8481
Mailing Address - Fax:
Practice Address - Street 1:1235 8TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4219
Practice Address - Country:US
Practice Address - Phone:505-425-6788
Practice Address - Fax:505-425-5408
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM72114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily