Provider Demographics
NPI:1043238264
Name:WASHINGTON, TERESA A (CNP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:A
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 WARRENSVILLE CENTER RD STE 250
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7000
Mailing Address - Country:US
Mailing Address - Phone:216-491-1178
Mailing Address - Fax:
Practice Address - Street 1:4200 WARRENSVILLE CENTER RD STE 250
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7000
Practice Address - Country:US
Practice Address - Phone:216-491-1178
Practice Address - Fax:216-491-8486
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06051363LA2200X
OHNP-06051363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2484020Medicaid
OH7753580OtherATENA
OH2484020Medicaid
OHQ15510Medicare UPIN