Individual
MR. SHANE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
1635 S DON ROSER DR, LAS CRUCES VA CBOC, LAS CRUCES, NM 88011-4550
(575) 522-1241
Mailing address
1635 S DON ROSER DR, LAS CRUCES VA CBOC, LAS CRUCES, NM 88011-4550
(575) 522-1241
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
CNP01132/R46618
NM
Other
Enumeration date
10/16/2008
Last updated
08/07/2015
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