Provider Demographics
NPI:1326747213
Name:RADOSEVICH, KARLA DEANNE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:DEANNE
Last Name:RADOSEVICH
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:DEANNE
Other - Last Name:RADOSEVICH-CHAVEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:7001 TOMBSTONE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-3503
Mailing Address - Country:US
Mailing Address - Phone:505-480-5076
Mailing Address - Fax:
Practice Address - Street 1:7001 TOMBSTONE RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-3503
Practice Address - Country:US
Practice Address - Phone:505-480-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR66181163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR66181OtherNEW MEXICO STATE BOARD OF NURSING