Provider Demographics
NPI:1467793778
Name:EVANS-GUYTON, TERESA M (CNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:EVANS-GUYTON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 SHAKER BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3873
Mailing Address - Country:US
Mailing Address - Phone:216-791-0017
Mailing Address - Fax:
Practice Address - Street 1:11201 SHAKER BLVD STE 240
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104
Practice Address - Country:US
Practice Address - Phone:216-791-0017
Practice Address - Fax:216-421-8377
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14252-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH14252-NPOtherCNP AUTHORITY