Healthcare Provider Details

I. General information

NPI: 1932503612
Provider Name (Legal Business Name): TERESSA ANN POWERS-FENTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 WOODLAWN AVE
RALSTON NE
68127-3704
US

IV. Provider business mailing address

PO BOX 67250
LINCOLN NE
68506-7250
US

V. Phone/Fax

Practice location:
  • Phone: 586-770-9715
  • Fax:
Mailing address:
  • Phone: 402-328-8833
  • Fax: 888-965-0959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112199
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: