Provider Demographics
NPI:1558514042
Name:LAGERLOF, TERESA K (NP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:K
Last Name:LAGERLOF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9312 VINTAGE CT
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7340
Mailing Address - Country:US
Mailing Address - Phone:440-255-2667
Mailing Address - Fax:
Practice Address - Street 1:24050 COMMERCE PARK
Practice Address - Street 2:SUITE 100
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5833
Practice Address - Country:US
Practice Address - Phone:216-896-9301
Practice Address - Fax:216-896-9302
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04197363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner