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NPI Code Detail

MEDICARE: MILAGROS MIRDO CNP

MEDICARE: MILAGROS MIRDO CNP
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
1363L00000XNurse Practitioner106689OK
2363LF0000XFamily Nurse Practitioner53572NM
3363LP0808XPsychiatric/Mental Health Nurse Practitioner53572NM

General Provider Information

NPI Number : 1336646975
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILAGROS MIRDO CNP
Provider Business Mailing Address
First Line : 6405 S 3000 E STE 300
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84121-6977
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4740 N BUTLER AVE
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-0826
Country : US
Telephone Number : 505-324-6300
Fax Number : 505-327-2218
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2018
Last Update Date : 03/01/2024

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Directions to “ MILAGROS MIRDO CNP” Practice Location

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