Individual
SHANA DRAKE-LAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
401 SAN MATEO BLVD SE, ALBUQUERQUE, NM 87108
(505) 462-7333
(505) 462-7301
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2022-0427
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Enumeration date
04/16/2019
Last updated
01/31/2025
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