Provider Demographics
NPI:1063693281
Name:TELFORD, GUADALUPE R (CNS)
Entity type:Individual
Prefix:MRS
First Name:GUADALUPE
Middle Name:R
Last Name:TELFORD
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:575-532-7161
Mailing Address - Fax:575-522-3743
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:575-532-7161
Practice Address - Fax:575-522-3743
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR 43287364SA2200X
NMCNS00174364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09030875Medicaid
NMNM302921OtherMEDICARE PTAN