Basic Information
| Provider Information | |||||||||
| NPI: | 1184781023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEUBERT | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 COLLINGTON PL | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357588577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562656512 | ||||||||
| FaxNumber: | 2562656727 | ||||||||
| Practice Location | |||||||||
| Address1: | 910 ADAMS ST SE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358013730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562656512 | ||||||||
| FaxNumber: | 2562656727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-058859 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1-058859 | 01 | AL | STATE LICENSE | OTHER |