Healthcare Provider Details

I. General information

NPI: 1316587272
Provider Name (Legal Business Name): TERESA ANN SLONE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 W BEARDSLEY RD
PEORIA AZ
85382-2652
US

IV. Provider business mailing address

9970 W BEARDSLEY RD
PEORIA AZ
85382-2652
US

V. Phone/Fax

Practice location:
  • Phone: 623-412-5410
  • Fax: 623-412-5407
Mailing address:
  • Phone: 623-412-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN191994
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: