Basic Information
| Provider Information | |||||||||
| NPI: | 1528127966 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOYLE | ||||||||
| FirstName: | TERI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 SAINT MICHAELS DR STE B104 | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875057671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059923334 | ||||||||
| FaxNumber: | 5059921998 | ||||||||
| Practice Location | |||||||||
| Address1: | 435 SAINT MICHAELS DR STE B104 | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875057671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059923334 | ||||||||
| FaxNumber: | 5059921998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | R49108 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | R49108 | 01 | NM | STATE LICENSE | OTHER |