Individual
VIVIANA VAN WAGONER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
203 CALIFORNIA ST NE, ALBUQUERQUE, NM 87108-1802
(505) 206-0288
Mailing address
203 CALIFORNIA ST NE, ALBUQUERQUE, NM 87108-1802
(505) 206-0288
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN-23043
NM
Other
Enumeration date
06/26/2025
Last updated
06/26/2025
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