Basic Information
| Provider Information | |||||||||
| NPI: | 1114231016 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEIRNS | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | BURNELLE | ||||||||
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| Credential: | RN, CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 MONTE AVE | ||||||||
| Address2: | C/O SHERRIS/LACITIS | ||||||||
| City: | PIEDMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946113718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012256167 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2051 JOHN JONES RD | ||||||||
| Address2: | DAVIS COMMUNITY CLINIC | ||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956169701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307582060 | ||||||||
| FaxNumber: | 5307588490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2010 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 730310 | CA | N | Nursing Service Providers | Registered Nurse | 367A00000X | 201601564NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 1904 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.