Healthcare Provider Details

I. General information

NPI: 1144350844
Provider Name (Legal Business Name): EVA F TOELLE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42121 US HWY 70
PORTALES NM
88130-9347
US

IV. Provider business mailing address

PO BOX 299
PORTALES NM
88130-0299
US

V. Phone/Fax

Practice location:
  • Phone: 575-356-6652
  • Fax: 575-359-6827
Mailing address:
  • Phone: 575-356-6652
  • Fax: 575-359-6827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110307
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28326
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP-02419
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: