MEDICARE: TERI RENEE COLE RN

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	163W00000X	Registered Nurse	RN086515	AZ

General Provider Information

NPI Number	:	1982792594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI RENEE COLE RN

Provider Business Mailing Address
First Line	:	5554 E ALDER AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-1410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 N STAPLEY DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-5604
Country	:	US
Telephone Number	:	480-835-9692
Fax Number	:	480-835-5457

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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