Provider Demographics
NPI:1982020392
Name:ANDERSON, TERESA LYNN (RN/CNM)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 CHALAN SAN ANTONIO PEMAR PLACE
Mailing Address - Street 2:C/O: MARIANAS PHYSICIAN GROUP
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-647-1830
Mailing Address - Fax:647-647-1919
Practice Address - Street 1:472 CHALAN SAN ANTONIO PEMAR PLACE
Practice Address - Street 2:C/O: MARIANAS PHYSICIAN GROUP
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-647-1830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURE-1861163W00000X
GUNP-0124367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse