Provider Demographics
NPI:1598096646
Name:ETTER, TERESA JEANNE (APRN-CNS)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:JEANNE
Last Name:ETTER
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427E CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5823
Mailing Address - Country:US
Mailing Address - Phone:580-234-7246
Mailing Address - Fax:580-233-2223
Practice Address - Street 1:3568 MCCLAFLIN DR
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7745
Practice Address - Country:US
Practice Address - Phone:580-234-7246
Practice Address - Fax:580-233-2223
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50268364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200281660AMedicaid
OKPTANOKA100023Medicare PIN