Provider Demographics
NPI:1629037312
Name:HARRIMAN, TERESA L (CRNA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:HARRIMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BRIARWOOD PL
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-9242
Mailing Address - Country:US
Mailing Address - Phone:304-428-1073
Mailing Address - Fax:304-428-1073
Practice Address - Street 1:103 BRIARWOOD PL
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-9242
Practice Address - Country:US
Practice Address - Phone:304-428-1073
Practice Address - Fax:304-428-1073
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA08960NA367500000X
WV44227367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2348829Medicaid
WV2603185000Medicaid
OH2348829Medicaid
WV2603185000Medicaid
WVHA6033491Medicare ID - Type Unspecified
OH2348829Medicaid
WV2603185000Medicaid