Healthcare Provider Details

I. General information

NPI: 1124146972
Provider Name (Legal Business Name): PAULA JEANNE LEDOUX RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 04/19/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 CALLE DON DIEGO
ESPANOLA NM
87532-3414
US

IV. Provider business mailing address

PO BOX 3227
SANTA FE NM
87501-0227
US

V. Phone/Fax

Practice location:
  • Phone: 505-367-3342
  • Fax: 505-747-0936
Mailing address:
  • Phone: 505-753-2256
  • Fax: 505-753-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR44560
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: