Provider Demographics
NPI:1063091882
Name:OESTREICH, TEENA MARIE
Entity type:Individual
Prefix:
First Name:TEENA
Middle Name:MARIE
Last Name:OESTREICH
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 1:848 13TH AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3729
Mailing Address - Country:US
Mailing Address - Phone:701-290-2308
Mailing Address - Fax:
Practice Address - Street 1:848 13TH AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3729
Practice Address - Country:US
Practice Address - Phone:701-290-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant