Healthcare Provider Details

I. General information

NPI: 1639095656
Provider Name (Legal Business Name): MICHELLE MAESTAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 CARLISLE BLVD NE STE 125
ALBUQUERQUE NM
87110-2865
US

IV. Provider business mailing address

2921 CARLISLE BLVD NE STE 125
ALBUQUERQUE NM
87110-2865
US

V. Phone/Fax

Practice location:
  • Phone: 505-554-1659
  • Fax:
Mailing address:
  • Phone: 505-554-1659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number90295
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: