Provider Demographics
NPI:1285158568
Name:MEZA, BLANCA ESTELA (FNP-BC)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:ESTELA
Last Name:MEZA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070B MERCURY CIR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87116-3024
Mailing Address - Country:US
Mailing Address - Phone:915-820-3297
Mailing Address - Fax:
Practice Address - Street 1:7001 SAN ANTONIO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4873
Practice Address - Country:US
Practice Address - Phone:915-820-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine