Healthcare Provider Details

I. General information

NPI: 1407300262
Provider Name (Legal Business Name): ANNA BLAUW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N DATE ST STE 8
T OR C NM
87901-2378
US

IV. Provider business mailing address

405 N DATE ST STE 8
T OR C NM
87901-2378
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-7589
  • Fax:
Mailing address:
  • Phone: 575-894-7589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM-08947
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: