Basic Information
| Provider Information | |||||||||
| NPI: | 1245463702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLLEM | ||||||||
| FirstName: | ASHA | ||||||||
| MiddleName: | DVORA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | C.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2661 FLORAL RD NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871041956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055507610 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2661 FLORAL RD NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871041956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055507610 | ||||||||
| FaxNumber: | 5052481351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2009 | ||||||||
| LastUpdateDate: | 03/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | R39757 | NM | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 363LP0808X | CNP-01814 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.