Healthcare Provider Details

I. General information

NPI: 1699746321
Provider Name (Legal Business Name): TERESA ANNE HASIK RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 LAMBERT INTERNATIONAL BLVD
BRIDGETON MO
63044-2314
US

IV. Provider business mailing address

432 BURNS AVE
KIRKWOOD MO
63122-3805
US

V. Phone/Fax

Practice location:
  • Phone: 314-263-6114
  • Fax:
Mailing address:
  • Phone: 314-965-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number139403
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: