Healthcare Provider Details

I. General information

NPI: 1477716736
Provider Name (Legal Business Name): TERESA M CASS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAC LN AVERA MEDICAL GROUP PIERRE
PIERRE SD
57501
US

IV. Provider business mailing address

100 MAC LN AVERA MEDICAL GROUP PIERRE
PIERRE SD
57501
US

V. Phone/Fax

Practice location:
  • Phone: 605-945-5246
  • Fax: 605-945-5295
Mailing address:
  • Phone: 605-945-5246
  • Fax: 605-945-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCP000526
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: