DESIREE RENEE PROVENCIO CNP NPI 1336648328

NPI Information

NPI: 1336648328
Provider Name: DESIREE RENEE PROVENCIO, CNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

Organization: PRESBYTERIAN MEDICAL SERVICES

PECOS Registration: Yes

Address:
184 UNSER BLVD NE
RIO RANCHO, NM
ZIP 87124
Phone: (505) 896-0928
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Desiree Renee Provencio, CNP is a psychiatric/mental health nurse practitioner in Rio Rancho, NM with 7 years of experience. Desiree Renee Provencio, CNP NPI is 1336648328. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

184 UNSER BLVD NE
RIO RANCHO, NM
ZIP 87124-045
Phone: (505) 896-0928

The NPI 1336648328 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/6/2018 and was last updated on 6/16/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	CNP-03491	NEW MEXICO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	CNP-03491	OTHER	NEW MEXICO	NEW MEXICO BOARD OF NURSING CNP LICENSURE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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