MEDICARE: MS. SHAWN BLAISDELL CFNP, CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	425	NM
2	363LF0000X	Family Nurse Practitioner	R37437	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083649065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAWN BLAISDELL CFNP, CNM

Provider Business Mailing Address
First Line	:	933 BRADBURY DR SE
Second Line	:	SUITE 2222
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4374
Country	:	US
Telephone Number	:	505-272-3120
Fax Number	:	505-272-8060

Provider Business Practice Location Address
First Line	:	1001 MEDICAL ARTS AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-2708
Country	:	US
Telephone Number	:	505-272-0457
Fax Number	:	505-272-2043

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	05/23/2012

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