Provider Demographics
NPI:1679744015
Name:CRUICKSHANK, THERESA M (RNC, NNP, MSN)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:CRUICKSHANK
Suffix:
Gender:F
Credentials:RNC, NNP, MSN
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:SCHROER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC, NNP, MSN
Mailing Address - Street 1:2933 WESTBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4546
Mailing Address - Country:US
Mailing Address - Phone:636-947-8647
Mailing Address - Fax:
Practice Address - Street 1:10010 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-4859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO066500363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal