DESIREE RENEE PROVENCIO (NPI# 1336648328) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336648328 |
| Entity Type | Individual |
| Full Name | DESIREE RENEE PROVENCIO |
| Credential | CNP |
| Practice Address |
184 Unser Blvd Ne Rio Rancho NM 87124-4045 |
| Practice Telephone | 5058960928 |
| Mailing Telephone | 5058960928 |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2018-06-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
CNP-03491 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | NEW MEXICO BOARD OF NURSING CNP LICENSURE | CNP-03491 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205023447 | Desiree Provencio | Counselor | 24625 Arch St, Santa Clarita, CA 91321-1111 | 2007-10-02 |
| Street Address |
184 UNSER BLVD NE |
| City | RIO RANCHO |
| State | NM |
| Zip Code | 87124-4045 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598733859 | Naishadh Ajitrai Mankad | Internal Medicine | 184 Unser Blvd Ne, Rio Rancho, NM 87124 | 2006-03-10 |
| 1891259222 | Marissa Koupf | Social Worker | 184 Unser Blvd Ne, Rio Rancho, NM 87124 | 2019-01-30 |
| 1073089926 | Christina Marie Hannah | Family Medicine | 184 Unser Blvd Ne, Rio Rancho, NM 87124-4045 | 2018-10-18 |
| 1629555438 | Frank Olivero Barreras | Case Manager/Care Coordinator | 184 Unser Blvd Ne, Rio Rancho, NM 87124-4045 | 2018-07-24 |
| 1902390966 | Stephen Joseph Frazier | Case Manager/Care Coordinator | 184 Unser Blvd Ne, Rio Rancho, NM 87124-4045 | 2018-06-21 |
| 1215440771 | Gloria Judith Aguilar Gurule | Case Manager/Care Coordinator | 184 Unser Blvd Ne, Rio Rancho, NM 87124 | 2017-11-07 |
| 1689185589 | Presbyterian Medical Services | Clinic/Center | 184 Unser Blvd Ne, Rio Rancho, NM 87124-4045 | 2017-10-18 |
| 1164947313 | Anthony Gregory Marquez | Social Worker | 184 Unser Blvd Ne, Rio Rancho, NM 87124-4045 | 2017-08-09 |
| 1467975763 | Damani Tryon Psr | Behavior Technician | 184 Unser Blvd Ne, Rio Rancho, NM 87124-4045 | 2017-07-19 |
| 1699298075 | Ruth Thelin | Case Manager/Care Coordinator | 184 Unser Blvd Ne, Rio Rancho, NM 87124-4045 | 2017-07-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740895648 | Dallon Knight | Pharmacist | 1115 Nm-528 Se, Rio Rancho, NM 87124 | 2020-09-09 |
| 1447875133 | Paul D Phillip | Counselor | 1207 Golf Course Rd Ne, Suite C, Rio Rancho, NM 87124 | 2020-06-09 |
| 1093341810 | Clearsky Rehabilitation Hospital of Rio Rancho LLC | Rehabilitation Hospital | 2401 Westside Blvd, Rio Rancho, NM 87124 | 2020-03-13 |
| 1841840345 | Debra English | Technician | 2001 Yucca St Se, Rio Rancho, NM 87124 | 2019-09-17 |
| 1114589322 | Counseling Connections, LLC | Counselor | 2600 Istle Rd Ne, Rio Rancho, NM 87124 | 2019-07-08 |
| 1417414996 | Kimberly Lovette Lorenzini | Counselor | Rio Rancho Family Counseling, 1340 Monterrey Rd, Rio Rancho, NM 87124 | 2019-02-21 |
| 1225507197 | Speech and Language Possibilities, LLC | Audiologist | 273 Tigris Road Ne, Rio Rancho, NM 87124 | 2018-11-20 |
| 1063997823 | Cindy Pendrey, LLC | Clinic/Center | 2103 Golf Course Rd Se, Suite A, Rio Rancho, NM 87124 | 2018-09-27 |
| 1972094324 | Calmar Inc. | Durable Medical Equipment & Medical Supplies | 2003 Southern Blvd Ne, Suite 123, Rio Rancho, NM 87124 | 2018-05-22 |
| 1013404581 | New Mexico Dental Clinics LLC | Dentist | 1594 Sara Rd Se Ste C, Rio Rancho, NM 87124 | 2018-04-19 |
| Find all providers in zip 87124 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417573338 | Awareness Integration LLC | Nurse Practitioner | 2101 Golf Course Rd Se Ste D, Rio Rancho, NM 87124-1760 | 2020-06-17 |
| 1427572577 | Mario Alberto Gutierrez | Nurse Practitioner | 1350 Jacke St. Se, Suite 104, Rio Rancho, NM 87124 | 2017-07-31 |
| 1659800894 | Integrated Healthcare | Nurse Practitioner | 4101 Barbara Loop Se Ste C, Rio Rancho, NM 87124-1011 | 2017-06-10 |
| 1124665237 | Denis Mbueha Muebake | Nurse Practitioner | 2300 Grande Blvd Se, Rio Rancho, NM 87124-1755 | 2019-12-09 |
| 1073908281 | Jacqueline Eva Willis | Nurse Practitioner | 4101 Barbara Loop Se, Suite D, Rio Rancho, NM 87124-1009 | 2015-04-03 |
| 1093114290 | Kimberley Durr | Nurse Practitioner | 2300 Grande Blvd Se, Rio Rancho, NM 87124-1755 | 2014-08-14 |
| 1003162736 | Jimmy Maggay Calzado | Nurse Practitioner | 1350 Jackie Rd Se, Suite 104, Rio Rancho, NM 87124-1519 | 2012-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477151116 | Lauren Jones Sparks | Nurse Practitioner | 9 Calle Venado, Santa Fe, NM 87506-0153 | 2020-10-14 |
| 1013524727 | Clarissa Juarez, LLC | Nurse Practitioner | 3900 Juan Tabo Blvd Ne Ste 4, Albuquerque, NM 87111-3978 | 2020-09-26 |
| 1053933721 | Canu Health, LLC | Nurse Practitioner | 2621 Cutler Ave Ne, Albuquerque, NM 87106-2511 | 2020-05-15 |
| 1477173896 | Diane Johnston, Pmhnp, LLC | Nurse Practitioner | 1619 Villa Strada, Santa Fe, NM 87506-4512 | 2020-04-27 |
| 1245869130 | Indigo Psychiatric Services | Nurse Practitioner | 609 Gold Ave Sw Ste 1-c, Albuquerque, NM 87102-3119 | 2020-04-03 |
| 1912534058 | Meredith Gamez | Nurse Practitioner | 5503 Grove Dr, Sunland Park, NM 88063-9594 | 2020-03-26 |
| 1619516358 | Permian Basin Brain Works Inc | Nurse Practitioner | 1601 N Turner St Ste 405, Hobbs, NM 88240-4331 | 2019-12-28 |
| 1194388496 | Anne E. Galanis | Nurse Practitioner | 100 Deputy Dean Miera Dr Sw: Bernalillo County Metropol, Albuquerque, NM 87151 | 2019-04-22 |
| 1689237380 | Bianca Lopez, LLC | Nurse Practitioner | 224 Anthony Dr, Anthony, NM 88021-9366 | 2019-04-17 |
| 1215400726 | Albert Hernandez Jr. | Nurse Practitioner | 5690 Santa Teresita Dr Ste A2, Santa Teresa, NM 88008-9211 | 2019-01-07 |
| Find all providers with the same taxonomy | ||||
| City | RIO RANCHO |
| Zip Code | 87124 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.