Individual
JELISA VICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
2211 LOMAS BLVD NE, TRAUMA/SURGICAL INTENSIVE CARE UNIT, ALBUQUERQUE, NM 87106
(505) 272-2721
Mailing address
PO BOX 967, FLAGSTAFF, AZ 86002-0967
(928) 773-0003
(928) 773-1170
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
AP8668
AZ
363LA2100X
Acute Care Nurse Practitioner
Primary
CNP-02725
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226889
—
AZ
Enumeration date
07/24/2015
Last updated
08/22/2023
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