MEDICARE: THERESA SCUDERI RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	099823	MO

General Provider Information

NPI Number	:	1427461862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA SCUDERI RN

Provider Business Mailing Address
First Line	:	3016 DUPONT CIR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6198
Country	:	US
Telephone Number	:	573-634-8142
Fax Number	:	573-634-8275

Provider Business Practice Location Address
First Line	:	3016 DUPONT CIR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6198
Country	:	US
Telephone Number	:	573-634-8142
Fax Number	:	573-634-8275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	06/03/2014

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