Provider Demographics
NPI:1982118196
Name:SZCZESNIAK, TERESA MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:SZCZESNIAK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:GUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:441 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2720
Mailing Address - Country:US
Mailing Address - Phone:267-237-8570
Mailing Address - Fax:
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-7890
Practice Address - Fax:215-456-8539
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN542701367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered