Provider Demographics
NPI:1700845849
Name:WERNER, TERI LOUISE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:LOUISE
Last Name:WERNER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7829 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8619
Mailing Address - Country:US
Mailing Address - Phone:920-757-8883
Mailing Address - Fax:
Practice Address - Street 1:W7829 SPRING RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942-8619
Practice Address - Country:US
Practice Address - Phone:920-757-8883
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI79391163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38346900Medicaid