Individual
JUDITH M VERGARA-BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1500 WALTER ST SE, ALBUQUERQUE, NM 87102-4658
(505) 272-1393
(505) 272-2177
Mailing address
933 BRADBURY DR SE, SUITE 2222, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
(505) 272-8060
Taxonomy
Speciality
Code
Description
License number
State
163WW0101X
Ambulatory Women's Health Care Registered Nurse
Primary
R51480
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
75502330
—
NM
Enumeration date
01/18/2006
Last updated
07/05/2023
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