Provider Demographics
NPI:1235203407
Name:DYESS, THERESA MARIA (RN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIA
Last Name:DYESS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MARIA
Other - Last Name:ABEYTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1956
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:505-758-4224
Mailing Address - Fax:505-751-5211
Practice Address - Street 1:1090 GOAT SPRINGS ROAD
Practice Address - Street 2:TAOS PICULIS INDIAN HEALTH CENTER
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-758-4224
Practice Address - Fax:505-751-5211
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR35691163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice