Provider Demographics
NPI:1023255510
Name:VALENCIA FAMILY MEDICINE & EXPRESS CARE
Entity type:Organization
Organization Name:VALENCIA FAMILY MEDICINE & EXPRESS CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:505-565-2232
Mailing Address - Street 1:311 S. LOS LENTES
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031
Mailing Address - Country:US
Mailing Address - Phone:505-565-2232
Mailing Address - Fax:505-565-2272
Practice Address - Street 1:311 S. LOS LENTES
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-565-2232
Practice Address - Fax:505-565-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR35144363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPENDINGOtherNPI