Provider Demographics
NPI:1245463702
Name:POLLEM, ASHA DVORA (CNP)
Entity type:Individual
Prefix:MS
First Name:ASHA
Middle Name:DVORA
Last Name:POLLEM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 FLORAL RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1956
Mailing Address - Country:US
Mailing Address - Phone:505-550-7610
Mailing Address - Fax:
Practice Address - Street 1:2661 FLORAL RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1956
Practice Address - Country:US
Practice Address - Phone:505-550-7610
Practice Address - Fax:505-248-1351
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR39757163WP0809X
NMCNP-01814363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult