Basic Information
| Provider Information | |||||||||
| NPI: | 1366766172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MISRA | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6211 4TH ST NW STE 1 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871075700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052260001 | ||||||||
| FaxNumber: | 3055548288 | ||||||||
| Practice Location | |||||||||
| Address1: | 6211 4TH ST NW STE 1 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871075700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052260001 | ||||||||
| FaxNumber: | 3055548288 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2010 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | CNP-01527 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 03407071 | 05 | NM | MEDICAID |