Provider Demographics
NPI:1508816232
Name:DONALDSON, TERESA LOUISE (CRNA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LOUISE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LOUISE
Other - Last Name:ILARDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1805 N CALIFORNIA ST
Mailing Address - Street 2:STE 101
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6037
Mailing Address - Country:US
Mailing Address - Phone:888-270-0340
Mailing Address - Fax:888-270-0331
Practice Address - Street 1:1805 N CALIFORNIA ST
Practice Address - Street 2:STE 101
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6037
Practice Address - Country:US
Practice Address - Phone:888-270-0340
Practice Address - Fax:888-270-0331
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN225414367500000X
CANA311367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN22541410Medicaid
CARN22541410Medicaid