Provider Demographics
NPI:1336457159
Name:OBERG, TERESA (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:OBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TESSIE
Other - Middle Name:
Other - Last Name:OBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1125 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1485
Mailing Address - Country:US
Mailing Address - Phone:712-255-8901
Mailing Address - Fax:712-255-9161
Practice Address - Street 1:1125 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1485
Practice Address - Country:US
Practice Address - Phone:712-255-8901
Practice Address - Fax:712-255-9161
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR034138163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse