Basic Information
| Provider Information | |||||||||
| NPI: | 1609480540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VEGA | ||||||||
| FirstName: | NORMA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1335 GERONIMO DR STE A | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799251836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155912704 | ||||||||
| FaxNumber: | 9155983946 | ||||||||
| Practice Location | |||||||||
| Address1: | 6974 GATEWAY BLVD E STE Y | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799151118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155912704 | ||||||||
| FaxNumber: | 9155983946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2020 | ||||||||
| LastUpdateDate: | 09/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1010578 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1010578 | 01 | TX | NP LICENCE | OTHER |