Individual
MEGAN JAYLYN VELASQUEZ-BACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN-APRN
Contact information
Practice address
114 ROAD 4599, BLANCO, NM 87412-8741
(505) 516-4909
Mailing address
PO BOX 305, BLANCO, NM 87412-0304
(505) 516-4909
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
62051
NM
Other
Enumeration date
11/20/2020
Last updated
02/18/2021
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