MEDICARE: MS. TERESA JO THOMSEN 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	R 132787-6	MN

General Provider Information

NPI Number	:	1699043505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERESA JO THOMSEN RN

Provider Business Mailing Address
First Line	:	13632 HEATHER HILLS DR
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-3908
Country	:	US
Telephone Number	:	952-236-7628
Fax Number	:

Provider Business Practice Location Address
First Line	:	13632 HEATHER HILLS DR
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-3908
Country	:	US
Telephone Number	:	952-236-7628
Fax Number	:

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

Provider Enumeration Date	:	12/06/2011
Last Update Date	:	12/06/2011

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