Provider Demographics
NPI:1831437441
Name:VANESSA'S FAMILY CLINIC
Entity type:Organization
Organization Name:VANESSA'S FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:575-941-2500
Mailing Address - Street 1:402 E WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-6500
Mailing Address - Country:US
Mailing Address - Phone:575-941-5000
Mailing Address - Fax:575-941-2503
Practice Address - Street 1:402 E WOOD AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-6500
Practice Address - Country:US
Practice Address - Phone:575-941-5000
Practice Address - Fax:575-941-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty