Healthcare Provider Details

I. General information

NPI: 1053248724
Provider Name (Legal Business Name): MICHELLE MERLET PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 LOUISIANA BLVD NE STE 1200
ALBUQUERQUE NM
87110-5495
US

IV. Provider business mailing address

3402 INDIAN SCHOOL RD NE APT D
ALBUQUERQUE NM
87106-1155
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number72591
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: