Healthcare Provider Details

I. General information

NPI: 1245128164
Provider Name (Legal Business Name): MICHAEL RYAN CAPSHAW RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8608 PRISTINE DR NE
ALBUQUERQUE NM
87122-4323
US

IV. Provider business mailing address

8608 PRISTINE DR NE
ALBUQUERQUE NM
87122-4323
US

V. Phone/Fax

Practice location:
  • Phone: 707-290-6126
  • Fax:
Mailing address:
  • Phone: 707-290-6126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number54792
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: