Basic Information
| Provider Information | |||||||||
| NPI: | 1407170426 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELGRANDE | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | LISA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8609 AZTEC RD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871114505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052944483 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1501 SAN PEDRO DRIVE SE | ||||||||
| Address2: | NEW MEXICO VA HEALTH CARE SYSTEM | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052651711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2010 | ||||||||
| LastUpdateDate: | 08/01/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | CNP-01652 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 364SP1700X | CNS00090 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Perinatal |
No ID Information.