Organization · NPI-2

Vdex Diabetes Nm-Brown

Nurse Practitioner · Espanola, NM

NPI number1144717075

StatusActive

Last updated in NPPESApr 16, 2018

Details

NPI: 1144717075
Entity type: Organization (NPI-2)
Legal business name: Vdex Diabetes Nm-Brown
Organization subpart: No
Enumeration date: Apr 16, 2018
Last updated: Apr 16, 2018

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363L00000X	Nurse Practitioner	–	–	Yes
133N00000X	Nutritionist	–	–
163WD0400X	Registered Nurse, Diabetes Educator	–	–

Practice location

1811 N Riverside Dr Ste C
Espanola, NM 87532-9550

Phone 505-747-0506 · Fax 505-747-0507

Mailing address

1811 N Riverside Dr Ste C
Espanola, NM 87532-9550

Phone 505-747-0506 · Fax 505-747-0507

Authorized official

Stephanie Sharon Brown
Provider
3034838967

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