Provider Demographics
NPI:1467457176
Name:BECKER, TERESA J (CFNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:BECKER
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:J
Other - Last Name:SADLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:SPRINGERVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85938-0639
Mailing Address - Country:US
Mailing Address - Phone:928-333-3353
Mailing Address - Fax:
Practice Address - Street 1:114 S MOUNTAIN AVENUE
Practice Address - Street 2:
Practice Address - City:SPRINGERVILLE
Practice Address - State:AZ
Practice Address - Zip Code:85938
Practice Address - Country:US
Practice Address - Phone:928-333-3353
Practice Address - Fax:928-333-3352
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN076750363LF0000X
NMR40216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ467797-04Medicaid
AZS53353Medicare UPIN
AZ68798Medicare ID - Type Unspecified