Individual
MR. ETHAN BLACKNEY-LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AG-ACNP
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-2711
Mailing address
9 SENA DR, LOS LUNAS, NM 87031-6948
(505) 507-3987
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
69604
NM
Other
Enumeration date
08/31/2022
Last updated
05/26/2023
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