Provider Demographics
NPI:1992201016
Name:DRUSTRUP, TERESA LYNN
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:DRUSTRUP
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 1:7315 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6821
Mailing Address - Country:US
Mailing Address - Phone:402-393-6911
Mailing Address - Fax:402-393-7838
Practice Address - Street 1:7315 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-6821
Practice Address - Country:US
Practice Address - Phone:402-393-6911
Practice Address - Fax:402-393-7838
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator