Healthcare Provider Details

I. General information

NPI: 1154831238
Provider Name (Legal Business Name): TERESA QUESADA GONZALES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 W 20TH AVE
APACHE JUNCTION AZ
85120-7392
US

IV. Provider business mailing address

2101 W 20TH AVE
APACHE JUNCTION AZ
85120-7392
US

V. Phone/Fax

Practice location:
  • Phone: 480-510-2542
  • Fax:
Mailing address:
  • Phone: 480-510-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN144574
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: