Individual
STACY JAQUE VIGIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
213 CHICO DR, LAS VEGAS, NM 87701-9511
(505) 429-5508
Mailing address
1264 RODEO RD, SANTA FE, NM 87505-6816
(505) 982-2129
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN-22383
NM
164X00000X
Licensed Vocational Nurse
LPN-22383
NM
171M00000X
Case Manager/Care Coordinator
—
—
376K00000X
Nurse's Aide
—
—
Other
Enumeration date
12/29/2017
Last updated
04/06/2020
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