Healthcare Provider Details

I. General information

NPI: 1891734547
Provider Name (Legal Business Name): JEAN SHIMANEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LP NE STE 214
ALBUQ NM
87109-2128
US

IV. Provider business mailing address

101 HOSPITAL LP NE STE 214
ALBUQ NM
87109-2128
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-6600
  • Fax: 505-883-0023
Mailing address:
  • Phone: 505-883-6600
  • Fax: 505-883-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number91307
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: