MEDICARE: LEANDRA J NIER ACNP-BC

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	363L00000X	Nurse Practitioner	CBP-01708	NM
2	363LA2100X	Acute Care Nurse Practitioner	CNP-01708	NM
3	363L00000X	Nurse Practitioner	CNP-01708	NM

General Provider Information

NPI Number	:	1861795171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANDRA J NIER ACNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 8354
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88202-8354
Country	:	US
Telephone Number	:	575-208-0106
Fax Number	:	575-208-0700

Provider Business Practice Location Address
First Line	:	1627 S UNION AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88203-2656
Country	:	US
Telephone Number	:	575-208-0106
Fax Number	:	575-208-0700

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

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	07/17/2024

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