Individual
SCOTT G VANDAWALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2800 DORAL CT, LAS CRUCES, NM 88011-8616
(575) 521-0055
(575) 521-0077
Mailing address
2800 DORAL CT, LAS CRUCES, NM 88011-8616
(575) 521-0055
(575) 521-0077
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
86563
CO
363LF0000X
Family Nurse Practitioner
Primary
81513
NM
363LF0000X
Family Nurse Practitioner
Primary
APN.0003114-NP
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000H1034
—
NM
05
—
98001574
—
CO
Enumeration date
11/13/2006
Last updated
01/21/2026
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