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General NPI Number Information
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NPI Number | 1417115239
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Entity Type | Individual
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Provider Name | ALICIA MAUREEN TEAUSANT DPM
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Gender | Female
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 02/03/2024
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Provider Practice Location Address
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Address Line | 2875 NE STUCKI AVE
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City | HILLSBORO
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State | OR
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Zip | 97124-5806
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Country | US
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Telephone | 503-652-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 765 N 34TH TER
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City | CORNELIUS
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State | OR
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Zip | 97124-5360
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Country | US
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Telephone | 480-993-8767
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | DP217454
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | PO60088822
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License Number State | WA
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