Provider Demographics
NPI:1881409126
Name:ROTERT, TERESA LYNN
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:ROTERT
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 1:1240 LOCUST ST # 363
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:NE
Mailing Address - Zip Code:69165-2087
Mailing Address - Country:US
Mailing Address - Phone:308-386-8568
Mailing Address - Fax:
Practice Address - Street 1:716 E 56TH ST APT I5
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-4826
Practice Address - Country:US
Practice Address - Phone:308-386-8568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant