Provider Demographics
NPI:1144616921
Name:TEASLEY, HANNAH AUTUMN HAVERKAMP
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:AUTUMN HAVERKAMP
Last Name:TEASLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:AUTUMN
Other - Last Name:HAVERKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:595 N MAIN ST
Mailing Address - Street 2:STE 2
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1821
Mailing Address - Country:US
Mailing Address - Phone:907-357-7781
Mailing Address - Fax:
Practice Address - Street 1:595 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1821
Practice Address - Country:US
Practice Address - Phone:541-488-1118
Practice Address - Fax:541-488-6409
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK38662163W00000X
AK1531163WW0101X
OR201911189NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory