Healthcare Provider Details

I. General information

NPI: 1114986080
Provider Name (Legal Business Name): TERESE A RISTEM CMRS, CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 COLONIAL RD
LAWRENCE MA
01843-3703
US

IV. Provider business mailing address

290 BROADWAY SUITE 395
METHUEN MA
01844-6827
US

V. Phone/Fax

Practice location:
  • Phone: 978-683-5115
  • Fax: 978-683-7337
Mailing address:
  • Phone: 978-683-5115
  • Fax: 978-683-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: