Provider Demographics
NPI:1982734612
Name:VASQUEZ-KISHBAUGH, ANA LUISA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LUISA
Last Name:VASQUEZ-KISHBAUGH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HOT SPRINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:NM
Mailing Address - Zip Code:88041
Mailing Address - Country:US
Mailing Address - Phone:505-536-3302
Mailing Address - Fax:505-537-5503
Practice Address - Street 1:900 CENTRAL
Practice Address - Street 2:
Practice Address - City:BAYARD
Practice Address - State:NM
Practice Address - Zip Code:88023
Practice Address - Country:US
Practice Address - Phone:505-537-4000
Practice Address - Fax:505-537-5503
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN30189163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice