Provider Demographics
NPI:1093166308
Name:CRALLE, TERESA (RN)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:
Last Name:CRALLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4531
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-4531
Mailing Address - Country:US
Mailing Address - Phone:434-996-4670
Mailing Address - Fax:
Practice Address - Street 1:14631 LEE HWY
Practice Address - Street 2:#413
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5824
Practice Address - Country:US
Practice Address - Phone:703-385-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001093802163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse