Provider Demographics
NPI:1033437140
Name:SCHENCK, TERESA DALE (DNP)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:DALE
Last Name:SCHENCK
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 DEVLIS GLENN RD
Mailing Address - Street 2:#615
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722
Mailing Address - Country:US
Mailing Address - Phone:563-265-2322
Mailing Address - Fax:
Practice Address - Street 1:3508 GREENBRIER DR
Practice Address - Street 2:TERESA SCHENCK DNP
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722
Practice Address - Country:US
Practice Address - Phone:563-265-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC064498363LP0200X
IAA064498363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAMS2158358OtherFEDERAL DEA