Provider Demographics
NPI:1982878294
Name:COUSINS, THERESA ANN
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:ANN
Last Name:COUSINS
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 1:1 GLENWOOD AVE
Mailing Address - Street 2:APT 1A
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2164
Mailing Address - Country:US
Mailing Address - Phone:347-242-7627
Mailing Address - Fax:718-790-9998
Practice Address - Street 1:1 GLENWOOD AVE
Practice Address - Street 2:APT 1A
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2164
Practice Address - Country:US
Practice Address - Phone:347-242-7627
Practice Address - Fax:718-790-9998
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1655521164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse