Healthcare Provider Details

I. General information

NPI: 1538164538
Provider Name (Legal Business Name): TERESA A RICHARDS C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA A CARUSO C.R.N.A

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 JOHNSONBURG ROAD ERPG ANESTHESIA SERVICES
ST. MARYS PA
15857
US

IV. Provider business mailing address

763 JOHNSONBURG ROAD ERPG ANESTHESIA SERVICES
ST. MARYS PA
15857
US

V. Phone/Fax

Practice location:
  • Phone: 814-788-8562
  • Fax: 814-788-8387
Mailing address:
  • Phone: 814-788-8562
  • Fax: 814-788-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number32295
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: