Provider Demographics
NPI:1902198393
Name:GATZULIS, TERESA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:GATZULIS
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 1:2345 PHILADELPHIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1816
Mailing Address - Country:US
Mailing Address - Phone:937-276-4141
Mailing Address - Fax:937-277-7249
Practice Address - Street 1:2345 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1816
Practice Address - Country:US
Practice Address - Phone:937-276-4141
Practice Address - Fax:937-277-7249
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN155584163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse