Provider Demographics
NPI:1275688194
Name:TESLUK, MARGARET (CRNA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:TESLUK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E ORANGEBURG AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5342
Mailing Address - Country:US
Mailing Address - Phone:209-526-3000
Mailing Address - Fax:209-526-3133
Practice Address - Street 1:400 E ORANGEBURG AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5342
Practice Address - Country:US
Practice Address - Phone:209-526-3000
Practice Address - Fax:209-526-3133
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406609163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN4066091OtherMEDICAL BILLING NUMBER
CARN4066091OtherMEDICAL BILLING NUMBER