Provider Demographics
NPI:1881065001
Name:BLACKWELL, LATANYUA (DNP, FNP-BC, NRCME)
Entity type:Individual
Prefix:DR
First Name:LATANYUA
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:DNP, FNP-BC, NRCME
Other - Prefix:DR
Other - First Name:LATANYUA
Other - Middle Name:
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-BC, NRCME
Mailing Address - Street 1:8226 MENAUL BLVD NE # 206
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4614
Mailing Address - Country:US
Mailing Address - Phone:877-629-6454
Mailing Address - Fax:505-212-0385
Practice Address - Street 1:8226 MENAUL BLVD NE # 206
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4614
Practice Address - Country:US
Practice Address - Phone:877-629-6454
Practice Address - Fax:505-212-0385
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR178174363LF0000X
ID69311363LF0000X
NY350752363LF0000X
NMCNP-02941363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care