Provider Demographics
NPI:1063042547
Name:TERESKA, SEREYA KORIN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:SEREYA
Middle Name:KORIN
Last Name:TERESKA
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 69TH ST APT 41
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77551-2061
Mailing Address - Country:US
Mailing Address - Phone:570-606-8108
Mailing Address - Fax:
Practice Address - Street 1:3102 69TH ST APT 41
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77551-2061
Practice Address - Country:US
Practice Address - Phone:570-606-8108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX973035163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics