Provider Demographics
NPI:1295724250
Name:TEEPLE, LILLIAN S (CRNA)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:S
Last Name:TEEPLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:S
Other - Last Name:MATUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-1849
Mailing Address - Country:US
Mailing Address - Phone:903-675-3202
Mailing Address - Fax:903-677-5586
Practice Address - Street 1:600 S BONHAM ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3603
Practice Address - Country:US
Practice Address - Phone:254-562-5332
Practice Address - Fax:903-677-5586
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216146367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R71136Medicare UPIN
8A7316Medicare ID - Type Unspecified