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General NPI Number Information
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NPI Number | 1740444934
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Entity Type | Individual
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Provider Name | VICKIE LYNNE SHELQUIST NP-C, FNP
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Gender | Female
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 138 WENDY RD
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City | SILVER CITY
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State | NM
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Zip | 88061-9789
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Country | US
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Telephone | 303-915-7712
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Fax | 575-342-5010
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Provider Business Mailing Address
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Address Line | 2340 HWY 180E PMB 239
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City | SILVER CITY
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State | NM
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Zip | 88061-8806
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Country | US
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Telephone | 303-915-7712
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Fax | 575-342-5010
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-03264
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License Number State | NM
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