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General NPI Number Information
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NPI Number | 1093573776
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Entity Type | Individual
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Provider Name | TERESA PUCKHABER APRN
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Gender | Female
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 114 S MAIN ST
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City | CHESHIRE
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State | CT
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Zip | 06410-3111
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Country | US
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Telephone | 860-485-7573
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Fax |
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Provider Business Mailing Address
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Address Line | 114 S MAIN ST
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City | CHESHIRE
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State | CT
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Zip | 06410-3111
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Country | US
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Telephone | 860-485-7573
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 6547
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 6547
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 6547
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License Number State | CT
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