Provider Demographics
NPI:1316481039
Name:RUPPRECHT, TERI A (CRNA)
Entity type:Individual
Prefix:MS
First Name:TERI
Middle Name:A
Last Name:RUPPRECHT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:RUPPRECHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE ANESTHETIST
Mailing Address - Street 1:20 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-4724
Mailing Address - Country:US
Mailing Address - Phone:347-387-7220
Mailing Address - Fax:
Practice Address - Street 1:20 LEE AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-4724
Practice Address - Country:US
Practice Address - Phone:347-387-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17381500163W00000X
NY542262-1163W00000X
NY542262367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1316481039Medicaid