That doesn't at all look like Nancy Pelosi.

Her skin wrinkles on the neck are missing. Nancy's face has a drawn and deathly look to it and her eyes are sunken in. The real Nancy Pelosi has really skinny, bony hands that look almost skeletal. The real Nancy Pelosi also tends to lick and play with her dentures while someone else is speaking.

This "replacement" Nancy seems to have a much healthier, younger and fleshier (fatter) face, a smooth neck and even her hands don't appear old. The nose also doesn't look quite like Nancy Pelosi's beak and this Nancy didn't play with her dentures.

I believe Nancy Pelosi may have been replaced.