Provider Demographics
NPI:1790238319
Name:MENOCHAT
Entity Type:Organization
Organization Name:MENOCHAT
Other - Org Name:DR. CHRISTY BLANCO, NURSE PRACTITIONER INTEGRATIVE MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CNP, WHNP-BC
Authorized Official - Phone:915-217-9300
Mailing Address - Street 1:5305 MCNUTT RD
Mailing Address - Street 2:204
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9685
Mailing Address - Country:US
Mailing Address - Phone:915-217-9300
Mailing Address - Fax:915-975-8074
Practice Address - Street 1:5305 MCNUTT RD
Practice Address - Street 2:204
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9685
Practice Address - Country:US
Practice Address - Phone:915-217-9300
Practice Address - Fax:915-975-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02155261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical