Provider Demographics
NPI:1124017322
Name:VERSTRAETE, TERESA H (ARNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:H
Last Name:VERSTRAETE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 W CENTRAL PARK AVE
Mailing Address - Street 2:STE 4300
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1853
Mailing Address - Country:US
Mailing Address - Phone:563-383-2763
Mailing Address - Fax:563-328-5500
Practice Address - Street 1:1351 W CENTRAL PARK AVE
Practice Address - Street 2:STE 4300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1853
Practice Address - Country:US
Practice Address - Phone:563-383-2763
Practice Address - Fax:563-328-5500
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA066913363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA31334OtherBCBS
IA16496Medicare ID - Type Unspecified
P53753Medicare UPIN