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General NPI Number Information
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NPI Number | 1639029259
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Entity Type | Individual
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Provider Name | DAKOTA BLU
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Gender | Female
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 1211 NEW YORK AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6727
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Country | US
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Telephone | 575-386-8127
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Fax |
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Provider Business Mailing Address
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Address Line | 103 FRESNO ST
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City | TULAROSA
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State | NM
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Zip | 88352-2739
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Country | US
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Telephone | 575-386-8127
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | G-1914
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License Number State | NM
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