| Doctor Name: | ANTHONY RAY TEASCK |
| NPI Number: | 1235462482 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CNP |
| License Number: | R1321681 |
| Business Practice Address: | 1101 9th St N Virginia, MN - 557922329 |
| Business Phone Number: | 2187410150 |
| Business Fax Number: | |
| Mailing Address: | 1101 9th St N, VIRGINIA |
| State: | MN |
| Postal Code: | 557922329 |
| Phone Number: | 2187410150 |
| Fax Number: | |
| NPI Enumeration Date: | 09/04/2009 |
| NPI Last Update Date: | 04/29/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | R1321681 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |