Provider Demographics
NPI:1326394206
Name:HENWOOD, TERESA KIM (BSN, RN)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:KIM
Last Name:HENWOOD
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9111
Mailing Address - Country:US
Mailing Address - Phone:315-635-0923
Mailing Address - Fax:
Practice Address - Street 1:112 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9111
Practice Address - Country:US
Practice Address - Phone:315-635-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY424762-1163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine