Provider Demographics
NPI:1437638657
Name:BARDWELL, SHEILA ANN (NP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ANN
Last Name:BARDWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:HOPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5087 VISTA CHICO LOOP
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-8353
Mailing Address - Country:US
Mailing Address - Phone:575-640-0748
Mailing Address - Fax:575-556-6533
Practice Address - Street 1:755 S TELSHOR BLVD STE R201
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8679
Practice Address - Country:US
Practice Address - Phone:575-640-0748
Practice Address - Fax:575-556-6539
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM53531363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care