Provider Demographics
NPI:1770593931
Name:TESKE, MARCELLA K (APNP)
Entity type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:K
Last Name:TESKE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-683-5278
Mailing Address - Fax:920-686-9674
Practice Address - Street 1:1620 N SHAWANO ST STE C
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-9318
Practice Address - Country:US
Practice Address - Phone:920-982-3870
Practice Address - Fax:920-982-3697
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1443-033363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43954700Medicaid
WI1443-033OtherSTATE LICENSE
WIMH0461448OtherDEA
WIP00690393OtherRAILROAD MEDICARE
WIMH0461448OtherDEA
WIP00690393OtherRAILROAD MEDICARE