Provider Demographics
NPI:1871682419
Name:REEDY, PAULA MARIE (CFNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:REEDY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:MARIE
Other - Last Name:PELLINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:1515 WEST FIR
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0843
Mailing Address - Country:US
Mailing Address - Phone:575-356-6695
Mailing Address - Fax:575-356-5948
Practice Address - Street 1:103 DON PABLO LANE
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:NM
Practice Address - Zip Code:88336
Practice Address - Country:US
Practice Address - Phone:575-653-4830
Practice Address - Fax:575-653-4833
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0066002363LP2300X
NMCNP01863363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care