Provider Demographics
NPI:1093187247
Name:HASTINGS, TERESA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANN
Last Name:HASTINGS
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 1:11 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-2106
Mailing Address - Country:US
Mailing Address - Phone:315-261-2646
Mailing Address - Fax:
Practice Address - Street 1:56 MARKET ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1747
Practice Address - Country:US
Practice Address - Phone:315-265-4065
Practice Address - Fax:315-265-0012
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY542240163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management