1760566038 NPI number — MRS. JANET GALE BACA CRNFA RN BSN CNOR

Table of content: MRS. JANET GALE BACA CRNFA RN BSN CNOR (NPI 1760566038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760566038 NPI number — MRS. JANET GALE BACA CRNFA RN BSN CNOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BACA
Provider First Name:
JANET
Provider Middle Name:
GALE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNFA RN BSN CNOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIXON
Provider Other First Name:
JANET
Provider Other Middle Name:
GALE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760566038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1311 CAMINO ECUESTRE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87107-2612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-345-4647
Provider Business Mailing Address Fax Number:
505-345-3127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1311 CAMINO ECUESTRE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87107-2612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-345-4647
Provider Business Practice Location Address Fax Number:
505-345-3127
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WR0006X , with the licence number:  R18882 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R79Z . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 3474983 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 0007286391 . This is a "AETNA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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