Provider Demographics
NPI:1962010538
Name:LAIN, TERESA JOANNA (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:JOANNA
Last Name:LAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:JOANNA
Other - Last Name:PLEWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12037 COPPER HILL PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3411
Mailing Address - Country:US
Mailing Address - Phone:928-533-5409
Mailing Address - Fax:
Practice Address - Street 1:12037 COPPER HILL PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3411
Practice Address - Country:US
Practice Address - Phone:928-533-5409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ154006163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse