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NPI Code Detail

MEDICARE: TERESSA RENEE CABALLERO LPN

MEDICARE: TERESSA RENEE CABALLERO LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseLP046708AZ

General Provider Information

NPI Number : 1417383902
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESSA RENEE CABALLERO LPN
Provider Business Mailing Address
First Line : 4221 E MCDOWELL RD APT 1006
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-7403
Country : US
Telephone Number : 602-829-6826
Fax Number :
Provider Business Practice Location Address
First Line : 4221 E MCDOWELL RD APT 1006
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-7403
Country : US
Telephone Number : 602-829-6826
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2013
Last Update Date : 09/17/2013

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Directions to “ TERESSA RENEE CABALLERO LPN” Practice Location

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