MEDICARE: TERESA I. GUTHRIE P.N.P.

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	363LP0200X	Pediatric Nurse Practitioner	F380872	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F380872	OTHER	NY	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1437149127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA I. GUTHRIE P.N.P.

Provider Business Mailing Address
First Line	:	1 MONTAUK HWY
Second Line	:
City	:	WEST SAYVILLE
State	:	NY
Zip	:	11796-1801
Country	:	US
Telephone Number	:	631-589-6727
Fax Number	:	631-244-2866

Provider Business Practice Location Address
First Line	:	1 MONTAUK HWY
Second Line	:
City	:	WEST SAYVILLE
State	:	NY
Zip	:	11796-1801
Country	:	US
Telephone Number	:	631-589-6727
Fax Number	:	631-244-2866

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	03/07/2023

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