Provider Demographics
NPI:1053026195
Name:HOPP, TERESA A (IBCLC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:HOPP
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9651 COUNTY ROAD 3570
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-0620
Mailing Address - Country:US
Mailing Address - Phone:580-490-1288
Mailing Address - Fax:
Practice Address - Street 1:9651 COUNTY ROAD 3570
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-0620
Practice Address - Country:US
Practice Address - Phone:580-490-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL-301281163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant