Doctor Name: | TERESA TRUSSELL |
NPI Number: | 1043695091 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APN |
License Number: | 209012262 |
Business Practice Address: | 2050 Claire Ct Glenview, IL - 600257635 |
Business Phone Number: | 8474677423 |
Business Fax Number: | 8475561715 |
Mailing Address: | 2050 Claire Ct, GLENVIEW |
State: | IL |
Postal Code: | 600257635 |
Phone Number: | 8474677423 |
Fax Number: | 8475561715 |
NPI Enumeration Date: | 07/20/2015 |
NPI Last Update Date: | 07/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 209012262 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |