Provider Demographics
NPI:1144717075
Name:VDEX DIABETES NM-BROWN
Entity type:Organization
Organization Name:VDEX DIABETES NM-BROWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:303-483-8967
Mailing Address - Street 1:1811 N RIVERSIDE DR STE C
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-9550
Mailing Address - Country:US
Mailing Address - Phone:505-747-0506
Mailing Address - Fax:505-747-0507
Practice Address - Street 1:1811 N RIVERSIDE DR STE C
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-9550
Practice Address - Country:US
Practice Address - Phone:505-747-0506
Practice Address - Fax:505-747-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty