Basic Information
| Provider Information | |||||||||
| NPI: | 1720319940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TERESCHUK | ||||||||
| FirstName: | ANASTASIA | ||||||||
| MiddleName: | MIKEL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ACNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TERESCHUK | ||||||||
| OtherFirstName: | ANASTASIA | ||||||||
| OtherMiddleName: | MIKEL | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSN RN ACNP-BC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 281 UNDERPASS DR | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378415885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235695454 | ||||||||
| FaxNumber: | 4235695932 | ||||||||
| Practice Location | |||||||||
| Address1: | 281 UNDERPASS DR | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378415885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235695454 | ||||||||
| FaxNumber: | 4235695932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2010 | ||||||||
| LastUpdateDate: | 07/30/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 157417 | TN | N | Nursing Service Providers | Registered Nurse | 363LA2100X | 14696 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 1031505037 | 01 | TN | MEDICARE | OTHER | 1518627 | 05 | TN | MEDICAID |