Provider Demographics
NPI:1669677951
Name:MEISENHALDER, TERESA (IDC)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:MEISENHALDER
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555657
Mailing Address - Street 2:1ST MEDICAL BATTALION, 22 GAS
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5657
Mailing Address - Country:US
Mailing Address - Phone:760-725-4912
Mailing Address - Fax:
Practice Address - Street 1:1ST MEDICAL BATTALION 22 GAS
Practice Address - Street 2:BLDG 22190
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5657
Practice Address - Country:US
Practice Address - Phone:760-725-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman