Provider Demographics
NPI:1700370285
Name:DEANE, TERI E (CREDENTIALED SN)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:E
Last Name:DEANE
Suffix:
Gender:F
Credentials:CREDENTIALED SN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E K ST STE 7
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3437
Mailing Address - Country:US
Mailing Address - Phone:707-748-2624
Mailing Address - Fax:
Practice Address - Street 1:350 E K ST
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3437
Practice Address - Country:US
Practice Address - Phone:707-748-2624
Practice Address - Fax:707-746-6152
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456131163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool