Provider Demographics
NPI:1437149127
Name:GUTHRIE, TERESA I (PNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:I
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WEST SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11796-1801
Mailing Address - Country:US
Mailing Address - Phone:631-589-6727
Mailing Address - Fax:631-244-2866
Practice Address - Street 1:1 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11796-1801
Practice Address - Country:US
Practice Address - Phone:631-589-6727
Practice Address - Fax:631-244-2866
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380872363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF380872OtherSTATE LICENSE NUMBER
NYF380872OtherSTATE LICENSE NUMBER