Provider Demographics
NPI:1932192002
Name:TUPPER, TERI A (ARNP)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:A
Last Name:TUPPER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:A
Other - Last Name:BIASI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6001 N. MAYFAIR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208
Mailing Address - Country:US
Mailing Address - Phone:509-462-2273
Mailing Address - Fax:509-462-2275
Practice Address - Street 1:6001 N MAYFAIR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1129
Practice Address - Country:US
Practice Address - Phone:509-462-2273
Practice Address - Fax:509-462-2275
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004871363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9623935Medicaid
WA9623935Medicaid
WAAB37440Medicare ID - Type Unspecified