Provider Demographics
NPI:1255448510
Name:DUCHATEAU, TERESA ANNE (APNP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANNE
Last Name:DUCHATEAU
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:ANNE
Other - Last Name:ROMMELFANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:950 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1306
Mailing Address - Country:US
Mailing Address - Phone:414-219-7745
Mailing Address - Fax:414-219-7709
Practice Address - Street 1:950 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53201
Practice Address - Country:US
Practice Address - Phone:414-219-7745
Practice Address - Fax:414-219-7753
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130148-030363L00000X
WI2547-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41255500Medicaid