Healthcare Provider Details

I. General information

NPI: 1891427530
Provider Name (Legal Business Name): ANNA BERNICE TEAGUE BSN, RN, SRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ANNA BERNICE CLUXTON

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

3200 BURNET AVE
CINCINNATI OH
45229-3019
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0021191
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: