Provider Demographics
NPI:1013452325
Name:MEAD-HAHN, TERESA LYNN
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:LYNN
Last Name:MEAD-HAHN
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 1:2922 ANGELIQUE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-3437
Mailing Address - Country:US
Mailing Address - Phone:816-387-3392
Mailing Address - Fax:
Practice Address - Street 1:2922 ANGELIQUE ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-3437
Practice Address - Country:US
Practice Address - Phone:816-387-3392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO55076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily