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General NPI Number Information
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NPI Number | 1295203446
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Entity Type | Individual
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Provider Name | THERESA A BEARDSLEY REGISTERED NURSE
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Gender | Female
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 12950 FREMONT AVE STE 1
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City | ZIMMERMAN
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State | MN
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Zip | 55398-4628
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Country | US
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Telephone | 763-294-0714
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Fax | 763-374-7161
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Provider Business Mailing Address
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Address Line | 12950 FREMONT AVE STE 1
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City | ZIMMERMAN
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State | MN
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Zip | 55398-4628
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Country | US
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Telephone | 320-235-7909
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Fax | 763-374-7161
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | R-1615096
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License Number State | MN
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