Provider Demographics
NPI:1154421139
Name:MURRELL, TERESA C (NP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:C
Last Name:MURRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:MULRENIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-824-4276
Mailing Address - Fax:
Practice Address - Street 1:10666 N TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1027
Practice Address - Country:US
Practice Address - Phone:858-554-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273016363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS76770Medicare UPIN
CAWNP4874AMedicare ID - Type Unspecified
CARN273016Medicaid
F637OtherCHAMPUS
CAWNP4874AMedicare ID - Type Unspecified