Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 425 | NM |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R37437 | NM |
NPI | 1083649065 |
---|---|
Provider Name | Ms. Shawn Blaisdell |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87102-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 23/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17605717 | (05) | NM |
P14910 | (02) |