Healthcare Provider Details

I. General information

NPI: 1114656477
Provider Name (Legal Business Name): STEPHANIE MINER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 OSUNA RD NE STE 5C
ALBUQUERQUE NM
87111-2072
US

IV. Provider business mailing address

8400 OSUNA RD NE STE 5C
ALBUQUERQUE NM
87111-2072
US

V. Phone/Fax

Practice location:
  • Phone: 505-585-2345
  • Fax:
Mailing address:
  • Phone: 505-585-2345
  • Fax: 505-800-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number68410
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: