Provider Demographics
NPI:1982214508
Name:CANTRELL, TERESA LEE
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LEE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7245 BEECH CREEK
Mailing Address - Street 2:
Mailing Address - City:MATEWAN
Mailing Address - State:WV
Mailing Address - Zip Code:25678
Mailing Address - Country:US
Mailing Address - Phone:304-426-9007
Mailing Address - Fax:
Practice Address - Street 1:7245 BEECH CREEK
Practice Address - Street 2:
Practice Address - City:MATEWAN
Practice Address - State:WV
Practice Address - Zip Code:25678
Practice Address - Country:US
Practice Address - Phone:304-426-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant