Provider Demographics
NPI:1003323015
Name:NOFEH, MIRABELLE
Entity Type:Individual
Prefix:
First Name:MIRABELLE
Middle Name:
Last Name:NOFEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4849 N MESA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5919
Mailing Address - Country:US
Mailing Address - Phone:915-351-6600
Mailing Address - Fax:915-351-6601
Practice Address - Street 1:13001 EASLAKE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-7803
Practice Address - Country:US
Practice Address - Phone:915-248-2345
Practice Address - Fax:915-271-4412
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP136065OtherAP LICENSE