Healthcare Provider Details

I. General information

NPI: 1881415685
Provider Name (Legal Business Name): MIRANDA ARREOLA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S PARK AVE
AZTEC NM
87410-2226
US

IV. Provider business mailing address

3503 MONTEREY CIR
FARMINGTON NM
87401-0836
US

V. Phone/Fax

Practice location:
  • Phone: 505-334-2852
  • Fax:
Mailing address:
  • Phone: 505-402-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number57295
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57295
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: