Healthcare Provider Details

I. General information

NPI: 1114474426
Provider Name (Legal Business Name): TIARA T MUHR RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SANDOVAL RD SW
LOS LUNAS NM
87031-7320
US

IV. Provider business mailing address

PO BOX 3469
LOS LUNAS NM
87031-3469
US

V. Phone/Fax

Practice location:
  • Phone: 505-565-4355
  • Fax:
Mailing address:
  • Phone: 505-565-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03086
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: