Healthcare Provider Details

I. General information

NPI: 1487605945
Provider Name (Legal Business Name): TERESA MARESH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2447 MONARCH DR APT. 2207
LAREDO TX
78045-6338
US

IV. Provider business mailing address

2447 MONARCH DR APT. 2207
LAREDO TX
78045-6338
US

V. Phone/Fax

Practice location:
  • Phone: 956-473-9494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number710725
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: