Provider Demographics
NPI:1346429149
Name:MCBANE, TERESA LEE (MOM)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LEE
Last Name:MCBANE
Suffix:
Gender:F
Credentials:MOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 W RALPH HALL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6659
Mailing Address - Country:US
Mailing Address - Phone:972-722-9000
Mailing Address - Fax:
Practice Address - Street 1:941 W RALPH HALL
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6659
Practice Address - Country:US
Practice Address - Phone:972-722-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00886171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist