Provider Demographics
NPI:1497702237
Name:SHERVANICK, CLAIRE ASHBURN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:ASHBURN
Last Name:SHERVANICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:ASHBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 MISSOURI AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5091
Mailing Address - Country:US
Mailing Address - Phone:575-404-7301
Mailing Address - Fax:575-207-0100
Practice Address - Street 1:2701 MISSOURI AVE STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-404-7301
Practice Address - Fax:575-207-0100
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0519207Q00000X
PAMD417594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68321864Medicaid
NM68321864Medicaid