Provider Demographics
NPI:1285148072
Name:PAEZ, TERESA (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:PAEZ
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 MONTGOMERY BLVD NE STE 105
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1246
Mailing Address - Country:US
Mailing Address - Phone:505-727-6797
Mailing Address - Fax:505-727-9979
Practice Address - Street 1:4705 MONTGOMERY BLVD NE STE 105
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1246
Practice Address - Country:US
Practice Address - Phone:505-727-6797
Practice Address - Fax:505-727-9979
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR26088163WL0100X
NML28802163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant