Individual
MISPER ETANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
2504 CAMINO ENTRADA, SANTA FE, NM 87507-4851
(505) 475-5006
Mailing address
14114 GROVEMIST LN, HOUSTON, TX 77082-2168
(832) 893-6879
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
58225
NM
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP141620
TX
Other
Enumeration date
10/20/2019
Last updated
12/05/2019
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