Healthcare Provider Details

I. General information

NPI: 1932912904
Provider Name (Legal Business Name): TERESA CARDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 EMILIO LOPEZ RD NW
LOS LUNAS NM
87031-7082
US

IV. Provider business mailing address

1776 EMILIO LOPEZ RD NW
LOS LUNAS NM
87031-7082
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-4646
  • Fax: 505-866-4796
Mailing address:
  • Phone: 505-865-4646
  • Fax: 505-866-4796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: