Provider Demographics
NPI:1629481528
Name:CONNER, TERESA LOUISE (APN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LOUISE
Last Name:CONNER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LOUISE
Other - Last Name:CAMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:401 ROUTE 73 N STE 320
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3426
Mailing Address - Country:US
Mailing Address - Phone:856-797-8886
Mailing Address - Fax:856-797-1149
Practice Address - Street 1:1 EVES DR STE 109
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3125
Practice Address - Country:US
Practice Address - Phone:856-797-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00488800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily