Provider Demographics
NPI:1851662308
Name:LEISTER, TERESA ANN (RN, BSN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:LEISTER
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 1:102 SHARON ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2654
Mailing Address - Country:US
Mailing Address - Phone:740-376-9418
Mailing Address - Fax:
Practice Address - Street 1:102 SHARON ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2654
Practice Address - Country:US
Practice Address - Phone:740-376-9418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 302343163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse