Provider Demographics
NPI:1699825315
Name:ACKERMAN, THERESA F (RN)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:F
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 ELEVENTH STREET
Mailing Address - Street 2:ROOM 172 TROTT ACCESS CENTER
Mailing Address - City:NIAGRA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-278-8110
Mailing Address - Fax:716-278-8111
Practice Address - Street 1:1001 ELEVENTH STREET
Practice Address - Street 2:ROOM 172 TROTT ACCESS CENTER
Practice Address - City:NIAGRA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-278-8110
Practice Address - Fax:716-278-8111
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2125821163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse