Provider Demographics
NPI:1235682964
Name:NEHLS, TERESA L
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:NEHLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 E RACINE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2344
Mailing Address - Country:US
Mailing Address - Phone:608-373-8000
Mailing Address - Fax:607-373-8006
Practice Address - Street 1:3400 E RACINE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2344
Practice Address - Country:US
Practice Address - Phone:608-373-8000
Practice Address - Fax:607-373-8006
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4861-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP01773630Medicare PIN
WIK400319870Medicare PIN