Provider Demographics
NPI:1326176181
Name:BLOCK, TERESA ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:BLOCK
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 1:1509 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-2542
Mailing Address - Country:US
Mailing Address - Phone:701-776-5145
Mailing Address - Fax:
Practice Address - Street 1:800 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-2118
Practice Address - Country:US
Practice Address - Phone:701-776-5261
Practice Address - Fax:701-776-5448
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR22221367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12538Medicaid
ND4014OtherBLUE CROSS BLUE SHIELD
ND12538Medicaid