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General NPI Number Information
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NPI Number | 1730169699
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Entity Type | Individual
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Provider Name | JUDITH M VERGARA-BLAKE CNP
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Gender | Female
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 1500 WALTER ST SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-4658
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Country | US
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Telephone | 505-272-1393
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Fax | 505-272-2177
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Provider Business Mailing Address
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Address Line | 933 BRADBURY DR SE SUITE 2222
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4374
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Country | US
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Telephone | 505-272-3120
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Fax | 505-272-8060
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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 | 163WW0101X
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Taxonomy Name | Ambulatory Women's Health Care Registered Nurse
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License Number | R51480
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License Number State | NM
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