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General NPI Number Information
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NPI Number | 1841714292
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Entity Type | Individual
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Provider Name | SHANNON GOINS-BLAIR CLT-LANA, AFMC, LMT
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Gender | Female
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 6800 MONTGOMERY BLVD NE STE G
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1425
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Country | US
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Telephone | 505-554-1855
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Fax |
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Provider Business Mailing Address
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Address Line | 20 CAMINO YRISARRI
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City | TIJERAS
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State | NM
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Zip | 87059-6300
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Country | US
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Telephone | 505-554-5185
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 8941
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | CLT
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | FUNCTIONALMEDICINE
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License Number State |
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