Individual
CLOYCE ELIZABETH BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
201 CEDAR ST SE STE 5660, ALBUQUERQUE, NM 87106-4920
(505) 563-6565
Mailing address
3723 SE 40TH AVE, PORTLAND, OR 97202-1710
(505) 818-3818
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA175856
OR
363A00000X
Physician Assistant
Primary
PA2016-0015
NM
363AS0400X
Surgical Physician Assistant
PA175856
OR
Other
Enumeration date
03/31/2016
Last updated
05/13/2019
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