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General NPI Number Information
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NPI Number | 1639538424
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Entity Type | Individual
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Provider Name | MISTY DAWN MORA CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 1265 ANTHONY DR.
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City | ANTHONY
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State | NM
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Zip | 88021-4530
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Country | US
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Telephone | 575-882-2956
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Fax | 575-882-1863
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Provider Business Mailing Address
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Address Line | P.O. BOX 4530
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City | ANTHONY
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State | TX
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Zip | 79821-4530
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Country | US
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Telephone | 575-882-2956
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Fax | 575-882-1863
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP129834
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | CNP-02836
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License Number State | NM
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