Healthcare Provider Details

I. General information

NPI: 1437638657
Provider Name (Legal Business Name): SHEILA ANN BARDWELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEILA HOPPER

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 07/03/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 HILLRISE DR STE 6
LAS CRUCES NM
88011-4776
US

IV. Provider business mailing address

5850 THIELMAN RD
LAS CRUCES NM
88005-4640
US

V. Phone/Fax

Practice location:
  • Phone: 575-640-0748
  • Fax: 575-567-7222
Mailing address:
  • Phone: 575-640-0748
  • Fax: 575-567-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number53531
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number53531
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: