MEDICARE: TERESA JEANNE ETTER APRN-CNS

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	163WC0200X	Critical Care Medicine Registered Nurse	R0050268	OK
2	364SC0200X	Critical Care Medicine Clinical Nurse Specialist	50268	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598096646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA JEANNE ETTER APRN-CNS

Provider Business Mailing Address
First Line	:	427 E CHEROKEE AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-5823
Country	:	US
Telephone Number	:	580-234-7246
Fax Number	:	580-233-2223

Provider Business Practice Location Address
First Line	:	427 E CHEROKEE AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-5823
Country	:	US
Telephone Number	:	580-234-7246
Fax Number	:	580-233-2223

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

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	03/04/2026

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