Basic Information
| Provider Information | |||||||||
| NPI: | 1285887737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRANDA | ||||||||
| FirstName: | ELEANOR | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C.N.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1209 UNIVERSITY BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871021727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052724400 | ||||||||
| FaxNumber: | 5052724211 | ||||||||
| Practice Location | |||||||||
| Address1: | 1209 UNIVERSITY BLVD NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871021727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052724400 | ||||||||
| FaxNumber: | 5052724211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2008 | ||||||||
| LastUpdateDate: | 10/28/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R39514 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.