MEDICARE: TEASA L CORMIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1386944098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEASA L CORMIER

Provider Business Mailing Address
First Line	:	23019 GOOD DALE LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-7009
Country	:	US
Telephone Number	:	832-721-1918
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 CYPRESS STATION DR APT 1808
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-1616
Country	:	US
Telephone Number	:	832-721-1918
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	10/27/2010

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Directions to “ TEASA L CORMIER ” Practice Location

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