MEDICARE: MIRABELLE NOFEH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP136065	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP136065	OTHER	TX	AP LICENSE

General Provider Information

NPI Number	:	1003323015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRABELLE NOFEH

Provider Business Mailing Address
First Line	:	4849 N MESA ST STE 201
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-5919
Country	:	US
Telephone Number	:	915-351-6600
Fax Number	:	915-351-6601

Provider Business Practice Location Address
First Line	:	11450 GATEWAY BLVD N STE 1100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79934-3460
Country	:	US
Telephone Number	:	915-271-4635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2017
Last Update Date	:	10/06/2025

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Directions to “ MIRABELLE NOFEH ” Practice Location

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