Provider Demographics
NPI:1679032908
Name:CARGILL, TERESA (PA-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CARGILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:TOMASZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 NE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3845
Mailing Address - Country:US
Mailing Address - Phone:231-383-0495
Mailing Address - Fax:
Practice Address - Street 1:915 NE VALLEY RD
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-3845
Practice Address - Country:US
Practice Address - Phone:509-332-3548
Practice Address - Fax:509-332-5253
Is Sole Proprietor?:No
Enumeration Date:2019-03-16
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60985315363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty