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NPI Code Detail

MEDICARE: TERESA LYNN GATZULIS RN

MEDICARE: TERESA LYNN GATZULIS 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
1163W00000XRegistered NurseRN155584OH

General Provider Information

NPI Number : 1902198393
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA LYNN GATZULIS RN
Provider Business Mailing Address
First Line : 2345 PHILADELPHIA DR
Second Line :
City : DAYTON
State : OH
Zip : 45406-1816
Country : US
Telephone Number : 937-276-4141
Fax Number : 937-277-7249
Provider Business Practice Location Address
First Line : 2345 PHILADELPHIA DR
Second Line :
City : DAYTON
State : OH
Zip : 45406-1816
Country : US
Telephone Number : 937-276-4141
Fax Number : 937-277-7249
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2011
Last Update Date : 05/04/2011

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