Healthcare Provider Details

I. General information

NPI: 1437482528
Provider Name (Legal Business Name): MRS. JEANA PILAR MIERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 DON FERNANDO ST
TAOS NM
87571-5953
US

IV. Provider business mailing address

314 DON FERNANDO ST
TAOS NM
87571-5953
US

V. Phone/Fax

Practice location:
  • Phone: 575-751-7037
  • Fax: 575-751-4586
Mailing address:
  • Phone: 575-751-7037
  • Fax: 575-751-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: