Healthcare Provider Details

I. General information

NPI: 1851739726
Provider Name (Legal Business Name): GILBERTA MIERA RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 YALE BLVD NE
ALBUQUERQUE NM
87106-3825
US

IV. Provider business mailing address

1001 YALE BLVD NE
ALBUQUERQUE NM
87106-3825
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2890
  • Fax: 505-272-1940
Mailing address:
  • Phone: 505-272-2890
  • Fax: 505-272-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR35126
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR35126
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: