Individual
LISA MICHELLE BACA-HUMMELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN, FNP
Contact information
Practice address
2437 CUTLER AVE NE, ALBUQUERQUE, NM 87106-2507
(505) 379-0311
Mailing address
2437 CUTLER AVE NE, ALBUQUERQUE, NM 87106-2507
(505) 379-0311
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
09211462
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09211462
NM BOARD OF NURSING, FAMILY NURSE PRACTITIONER LICENSE
NM
Enumeration date
12/28/2021
Last updated
12/29/2021
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