Basic Information
Provider Information | |||||||||
NPI: | 1518196351 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ORTIZ-AVALOS | ||||||||
FirstName: | VANESSA | ||||||||
MiddleName: | LYNN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ORTIZ | ||||||||
OtherFirstName: | VANESSA | ||||||||
OtherMiddleName: | LYNN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 801 N BEDELL AVE | ||||||||
Address2: |   | ||||||||
City: | DEL RIO | ||||||||
State: | TX | ||||||||
PostalCode: | 788404112 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8307689200 | ||||||||
FaxNumber: | 8307743534 | ||||||||
Practice Location | |||||||||
Address1: | 801 N BEDELL AVE | ||||||||
Address2: |   | ||||||||
City: | DEL RIO | ||||||||
State: | TX | ||||||||
PostalCode: | 788404112 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8302820085 | ||||||||
FaxNumber: | 8307743534 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/14/2009 | ||||||||
LastUpdateDate: | 05/06/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/06/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 763956 | TX | Y |   | Nursing Service Providers | Registered Nurse |   |
ID Information
ID | Type | State | Issuer | Description | 763956 | 01 | TX | LICENSE | OTHER | AP136990 | 01 | TX | APRN | OTHER |