Provider Demographics
NPI:1558993618
Name:TEDERS, JANE MARIE
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:MARIE
Last Name:TEDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-3806
Mailing Address - Country:US
Mailing Address - Phone:817-645-2445
Mailing Address - Fax:817-645-5079
Practice Address - Street 1:502 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-3806
Practice Address - Country:US
Practice Address - Phone:817-645-2445
Practice Address - Fax:817-645-5079
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist