Provider Demographics
NPI:1336233121
Name:CROMEANS, JACQUELINE L (CNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:CROMEANS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 DR MARTIN LUTHER KING JR AVE NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3661
Mailing Address - Country:US
Mailing Address - Phone:505-727-3040
Mailing Address - Fax:505-727-3099
Practice Address - Street 1:715 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3661
Practice Address - Country:US
Practice Address - Phone:505-727-3040
Practice Address - Fax:505-727-3099
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR49381207P00000X
NMCNP01224363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30838827Medicaid
NM30838827Medicaid
N/AMedicare PIN