Healthcare Provider Details

I. General information

NPI: 1528350451
Provider Name (Legal Business Name): TERESA M PULVERMACHER ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PINE ST
LA CROSSE WI
54601-3481
US

IV. Provider business mailing address

333 FRONT ST N
LA CROSSE WI
54601-3220
US

V. Phone/Fax

Practice location:
  • Phone: 608-668-2103
  • Fax: 833-997-3923
Mailing address:
  • Phone: 608-668-2103
  • Fax: 833-997-3923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4305
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4305-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number116838
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: