Healthcare Provider Details

I. General information

NPI: 1649615501
Provider Name (Legal Business Name): TESHA KATRINA KUHL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33142 CAMAS SWALE RD
CRESWELL OR
97426-9732
US

IV. Provider business mailing address

1240 ROSE ST
JUNCTION CITY OR
97448-1176
US

V. Phone/Fax

Practice location:
  • Phone: 541-510-3919
  • Fax:
Mailing address:
  • Phone: 541-998-4532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number201230114
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: