Healthcare Provider Details

I. General information

NPI: 1497646863
Provider Name (Legal Business Name): SUSIE MARIE BLANCO APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 W AMADOR AVE
LAS CRUCES NM
88005-2739
US

IV. Provider business mailing address

999 W AMADOR AVE
LAS CRUCES NM
88005-2739
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-5482
  • Fax:
Mailing address:
  • Phone: 575-527-5482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number91212
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-82334
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: