Provider Demographics
NPI:1235246877
Name:WOODFILL, TERESA K (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:K
Last Name:WOODFILL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WOODFILL ROAD
Mailing Address - Street 2:P.O. BOX 113
Mailing Address - City:LINDRITH
Mailing Address - State:NM
Mailing Address - Zip Code:87029
Mailing Address - Country:US
Mailing Address - Phone:505-774-6672
Mailing Address - Fax:505-774-6664
Practice Address - Street 1:6349 ST HWY 550
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NM
Practice Address - Zip Code:87013
Practice Address - Country:US
Practice Address - Phone:505-289-3291
Practice Address - Fax:505-289-3648
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR17241163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator