Provider Demographics
NPI:1114294147
Name:RASKAUSKAS, THERESA ANNE (MSN, FNP-BC, PMHNP-B)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANNE
Last Name:RASKAUSKAS
Suffix:
Gender:F
Credentials:MSN, FNP-BC, PMHNP-B
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 31001-0698
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0698
Mailing Address - Country:US
Mailing Address - Phone:602-263-1200
Mailing Address - Fax:
Practice Address - Street 1:4212 N 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-163-1200
Practice Address - Fax:602-263-1625
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN206698363LP0808X
AZAP10020363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP10020OtherAPN LICENSE
AZRN206698OtherRN LICENSE