Individual
JEANNINE M ACANTILADO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1819
(505) 841-1998
Mailing address
5901 HARPER DR NE, ALBUQUERQUE, NM 87109-3587
(505) 823-8556
(505) 823-8555
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R54517
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NM
Enumeration date
05/12/2006
Last updated
07/08/2007
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