MEDICARE: TERESA RENEE BOSTON 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	163W00000X	Registered Nurse	646288	TX

General Provider Information

NPI Number	:	1477417806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA RENEE BOSTON RN

Provider Business Mailing Address
First Line	:	PO BOX 1223
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-1223
Country	:	US
Telephone Number	:	864-560-7078
Fax Number	:	864-560-5369

Provider Business Practice Location Address
First Line	:	PO BOX 1223
Second Line	:
City	:	WHARTON
State	:	TX
Zip	:	77488-1223
Country	:	US
Telephone Number	:	864-560-7078
Fax Number	:	864-560-5369

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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