Provider Demographics
NPI:1861795171
Name:NIER, LEANDRA J (ACNP-BC)
Entity type:Individual
Prefix:
First Name:LEANDRA
Middle Name:J
Last Name:NIER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8354
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-8354
Mailing Address - Country:US
Mailing Address - Phone:575-208-0106
Mailing Address - Fax:575-208-0700
Practice Address - Street 1:1627 S UNION AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-2656
Practice Address - Country:US
Practice Address - Phone:575-208-0106
Practice Address - Fax:575-208-0700
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCBP-01708363L00000X
NMCNP-01708363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care