1871682419 NPI number — PAULA MARIE REEDY CFNP

Table of content: PAULA MARIE REEDY CFNP (NPI 1871682419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871682419 NPI number — PAULA MARIE REEDY CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REEDY
Provider First Name:
PAULA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PELLINI
Provider Other First Name:
PAULA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871682419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 843
Provider Second Line Business Mailing Address:
1515 WEST FIR
Provider Business Mailing Address City Name:
PORTALES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88130-0843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-356-6695
Provider Business Mailing Address Fax Number:
575-356-5948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 DON PABLO LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-653-4830
Provider Business Practice Location Address Fax Number:
575-653-4833
Provider Enumeration Date:
10/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  R0066002 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: CNP01863 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)