Provider Demographics
NPI:1467688895
Name:ANSBERRY, TERESA L (LPN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:ANSBERRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6492 BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9361
Mailing Address - Country:US
Mailing Address - Phone:740-432-2066
Mailing Address - Fax:
Practice Address - Street 1:6492 BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9361
Practice Address - Country:US
Practice Address - Phone:740-432-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.109441164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse