Provider Demographics
NPI:1225398134
Name:TETZLAFF, TERESE TYSON (RN)
Entity Type:Individual
Prefix:MS
First Name:TERESE
Middle Name:TYSON
Last Name:TETZLAFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:TERESE
Other - Middle Name:TETZLAFF
Other - Last Name:TYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 GLACIER HILL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-8589
Mailing Address - Country:US
Mailing Address - Phone:608-243-8246
Mailing Address - Fax:
Practice Address - Street 1:910 MAYER AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4256
Practice Address - Country:US
Practice Address - Phone:608-285-6757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84481-30163WI0600X, 163WP0809X, 163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health