MEDICARE: TERESA NYINGI COON RN

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
1	163W00000X	Registered Nurse	RN-76685	NM

General Provider Information

NPI Number	:	1699271015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA NYINGI COON RN

Provider Business Mailing Address
First Line	:	10827 WOLF CREEK RD SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-5917
Country	:	US
Telephone Number	:	505-440-7126
Fax Number	:

Provider Business Practice Location Address
First Line	:	UPLIFT PROFESSIONALS NETWORK
Second Line	:	3956 TOWN CENTER
City	:	ORLANDO
State	:	FL
Zip	:	32837-3283
Country	:	US
Telephone Number	:	407-512-0183
Fax Number	:	888-717-4335

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	04/04/2018

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