Provider Demographics
NPI:1457784209
Name:TEDESCHI, PHYLLIS MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:MARIE
Last Name:TEDESCHI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 WASHINGTON ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1760
Mailing Address - Country:US
Mailing Address - Phone:781-249-0740
Mailing Address - Fax:
Practice Address - Street 1:1 COMPASS WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:E BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1465
Practice Address - Country:US
Practice Address - Phone:508-350-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN236485363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily