Provider Demographics
NPI:1972518330
Name:MOORE-ALVAREZ, VICKIE (MSN)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:
Last Name:MOORE-ALVAREZ
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W GRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1234
Mailing Address - Country:US
Mailing Address - Phone:575-522-7260
Mailing Address - Fax:575-522-1355
Practice Address - Street 1:100 W GRIGGS AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1234
Practice Address - Country:US
Practice Address - Phone:575-522-7260
Practice Address - Fax:575-522-1355
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60545791363LP0808X
NMCNS00066364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP15943Medicare UPIN