Healthcare Provider Details

I. General information

NPI: 1215049895
Provider Name (Legal Business Name): TEDDA JEAN SAUNDERS RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 LAKEWOOD DR
RICHMOND VA
23229-7413
US

IV. Provider business mailing address

204 LAKEWOOD DR
RICHMOND VA
23229-7413
US

V. Phone/Fax

Practice location:
  • Phone: 804-221-6728
  • Fax:
Mailing address:
  • Phone: 804-221-6728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001041476
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015000406
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: