Healthcare Provider Details

I. General information

NPI: 1740444934
Provider Name (Legal Business Name): VICKIE LYNNE SHELQUIST NP-C, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 WENDY RD
SILVER CITY NM
88061-9789
US

IV. Provider business mailing address

2340 HWY 180E PMB 239
SILVER CITY NM
88061-8806
US

V. Phone/Fax

Practice location:
  • Phone: 303-915-7712
  • Fax: 575-342-5010
Mailing address:
  • Phone: 303-915-7712
  • Fax: 575-342-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03264
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: