Provider Demographics
NPI:1639274962
Name:MUNSON, TERESA H (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:H
Last Name:MUNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:H
Other - Last Name:STOUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1536 BARCLAY STREET
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1406
Mailing Address - Country:US
Mailing Address - Phone:651-771-7574
Mailing Address - Fax:
Practice Address - Street 1:255 NORTH SMITH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-292-0616
Practice Address - Fax:651-298-1203
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 132837-0163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse