Provider Demographics
NPI:1588034813
Name:TEAGUE, VIRGINIA (RN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HAWTHORN ST
Mailing Address - Street 2:APT. A
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-3615
Mailing Address - Country:US
Mailing Address - Phone:978-551-0906
Mailing Address - Fax:
Practice Address - Street 1:15 HAWTHORN ST
Practice Address - Street 2:APT. A
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-3615
Practice Address - Country:US
Practice Address - Phone:978-551-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2303508163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse