Provider Demographics
NPI:1477654796
Name:SONDERMANN, TERESA ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANN
Last Name:SONDERMANN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 W REPUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5730
Mailing Address - Country:US
Mailing Address - Phone:417-425-2555
Mailing Address - Fax:417-891-4913
Practice Address - Street 1:1850 W REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5730
Practice Address - Country:US
Practice Address - Phone:417-891-4800
Practice Address - Fax:417-891-4913
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO094587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428816409Medicaid
185622OtherBLUE CROSS OF MO
185622OtherBLUE CROSS OF MO
Q06746Medicare UPIN