Provider Demographics
NPI:1659763928
Name:CYRUS, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CYRUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21897 S DIAMOND LAKE RD STE 400-403
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4642
Mailing Address - Country:US
Mailing Address - Phone:763-317-1122
Mailing Address - Fax:
Practice Address - Street 1:21897 S DIAMOND LAKE RD STE 400-403
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4642
Practice Address - Country:US
Practice Address - Phone:763-317-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 3692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily