Provider Demographics
NPI:1417383902
Name:CABALLERO, TERESSA RENEE (LPN)
Entity type:Individual
Prefix:
First Name:TERESSA
Middle Name:RENEE
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 E MCDOWELL RD APT 1006
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7403
Mailing Address - Country:US
Mailing Address - Phone:602-829-6826
Mailing Address - Fax:
Practice Address - Street 1:4221 E MCDOWELL RD APT 1006
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7403
Practice Address - Country:US
Practice Address - Phone:602-829-6826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP046708164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse