Healthcare Provider Details

I. General information

NPI: 1881065001
Provider Name (Legal Business Name): LATANYUA BLACKWELL DNP, FNP-BC, NRCME
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATANYUA BLACKWELL DNP, FNP-BC, NRCME

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8226 MENAUL BLVD NE # 206
ALBUQUERQUE NM
87110-4614
US

IV. Provider business mailing address

8226 MENAUL BLVD NE # 206
ALBUQUERQUE NM
87110-4614
US

V. Phone/Fax

Practice location:
  • Phone: 877-629-6454
  • Fax: 505-212-0385
Mailing address:
  • Phone: 877-629-6454
  • Fax: 505-212-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR178174
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69311
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number350752
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCNP-02941
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02941
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: