Provider Demographics
NPI:1568460731
Name:NORTH, TERESA EILEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:EILEEN
Last Name:NORTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 F ST
Mailing Address - Street 2:STE 111
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3226
Mailing Address - Country:US
Mailing Address - Phone:916-452-8291
Mailing Address - Fax:916-452-1733
Practice Address - Street 1:5301 F ST
Practice Address - Street 2:STE 111
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3226
Practice Address - Country:US
Practice Address - Phone:916-452-8291
Practice Address - Fax:916-452-1733
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 10502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046820Medicaid
CAGR0046820Medicaid
OPA 10502Medicare UPIN