Individual
MISTY DAWN MORA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
1265 ANTHONY DR., ANTHONY, NM 88021-4530
(575) 882-2956
(575) 882-1863
Mailing address
P.O. BOX 4530, ANTHONY, TX 79821-4530
(575) 882-2956
(575) 882-1863
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
AP129834
TX
363LP0200X
Pediatric Nurse Practitioner
Primary
CNP-02836
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20153731
PNCB
—
01
—
AP129834
TEXAS BOARD OF NURSING
TX
01
—
CNP-02836
NEW MEXICO BOARD OF NURSING
NM
Enumeration date
02/22/2016
Last updated
04/23/2018
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