Provider Demographics
NPI:1013095538
Name:BLANCO, CHRISTINA ESTRELLITA (RNC, WHCNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ESTRELLITA
Last Name:BLANCO
Suffix:
Gender:F
Credentials:RNC, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 FINSTERWALD PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6011
Mailing Address - Country:US
Mailing Address - Phone:817-209-4946
Mailing Address - Fax:915-500-4714
Practice Address - Street 1:1245 COUNTRY CLUB RD STE 200
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9743
Practice Address - Country:US
Practice Address - Phone:575-332-4633
Practice Address - Fax:575-332-4635
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP112871363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74039318Medicaid
TX130880104Medicaid