Provider Demographics
NPI:1205543865
Name:PALLARES, SHAE M (CNM)
Entity type:Individual
Prefix:
First Name:SHAE
Middle Name:M
Last Name:PALLARES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 ROYAL DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4926
Mailing Address - Country:US
Mailing Address - Phone:575-644-8747
Mailing Address - Fax:
Practice Address - Street 1:4351 E LOHMAN AVE STE 402
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8261
Practice Address - Country:US
Practice Address - Phone:575-522-4767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM876367A00000X
TX1098267367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife