Provider Demographics
NPI:1043863434
Name:GARAD, TERESIA (NP-C (PENDINGLICENSE)
Entity Type:Individual
Prefix:
First Name:TERESIA
Middle Name:
Last Name:GARAD
Suffix:
Gender:F
Credentials:NP-C (PENDINGLICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1207
Mailing Address - Country:US
Mailing Address - Phone:617-251-1040
Mailing Address - Fax:
Practice Address - Street 1:329 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1207
Practice Address - Country:US
Practice Address - Phone:617-251-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2303266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily