Basic Information
Provider Information | |||||||||
NPI: | 1033187802 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BELINSKY | ||||||||
FirstName: | JACQUELYN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 455 SAINT MICHAELS DR | ||||||||
Address2: | PHYSICIAN PRACTICES | ||||||||
City: | SANTA FE | ||||||||
State: | NM | ||||||||
PostalCode: | 875057601 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5059954901 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2025 GALISTEO ST | ||||||||
Address2: |   | ||||||||
City: | SANTA FE | ||||||||
State: | NM | ||||||||
PostalCode: | 875052101 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5059954901 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/09/2006 | ||||||||
LastUpdateDate: | 09/22/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R39419 | NM | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | 10010584 | 01 |   | LOVELACE | OTHER | NM006950 | 01 | NM | BCBS NM | OTHER | 201038480 | 01 |   | PRESBYTERIAN HEALTH PLANS | OTHER | 48059889 | 05 | NM |   | MEDICAID | QMYPR0068044 | 01 |   | MOLINA | OTHER | 2511164 | 01 |   | UHC | OTHER |