Healthcare Provider Details

I. General information

NPI: 1114833258
Provider Name (Legal Business Name): IRMA JOY SHRUM APRN FNP-C, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 8TH ST
LAS VEGAS NM
87701-4219
US

IV. Provider business mailing address

826 NEW MEXICO AVE
LAS VEGAS NM
87701-3244
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-6788
  • Fax:
Mailing address:
  • Phone: 505-429-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number91330
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: