| Doctor Name: | TERESA GAYLE WAUGH |
| NPI Number: | 1003923699 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, CDE |
| License Number: | 45590 |
| Business Practice Address: | 3110 Maccorkle Ave Se Charleston, WV - 25304 |
| Business Phone Number: | 3043885555 |
| Business Fax Number: | 3043555560 |
| Mailing Address: | Rt 1 Box 173 K, LIBERTY |
| State: | WV |
| Postal Code: | 25124 |
| Phone Number: | 3045863012 |
| Fax Number: | |
| NPI Enumeration Date: | 08/23/2006 |
| NPI Last Update Date: | 06/04/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | 45590 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |