Provider Demographics
NPI:1386091544
Name:LANDRY, JOSHUA JOEL (MSN, RN, NCSN)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JOEL
Last Name:LANDRY
Suffix:
Gender:M
Credentials:MSN, RN, NCSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N WHITE SANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6246
Mailing Address - Country:US
Mailing Address - Phone:575-439-4457
Mailing Address - Fax:
Practice Address - Street 1:1900 N WHITE SANDS BLVD
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6246
Practice Address - Country:US
Practice Address - Phone:575-439-4457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR67999163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool