Provider Demographics
NPI:1083041826
Name:PEARSON, TETEISHA TIANNA (CRNA)
Entity Type:Individual
Prefix:
First Name:TETEISHA
Middle Name:TIANNA
Last Name:PEARSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SHAKER HTS
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1285
Mailing Address - Country:US
Mailing Address - Phone:646-496-2341
Mailing Address - Fax:
Practice Address - Street 1:111 SHAKER HTS
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1285
Practice Address - Country:US
Practice Address - Phone:646-496-2341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-10
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY599276-1163W00000X, 367500000X
NY592276367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse