Provider Demographics
NPI:1386832053
Name:KAUFMAN, TERESA (CNA)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 SE COLE RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9258
Mailing Address - Country:US
Mailing Address - Phone:360-427-4003
Mailing Address - Fax:360-427-2734
Practice Address - Street 1:1420 SE COLE RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-9258
Practice Address - Country:US
Practice Address - Phone:360-427-4003
Practice Address - Fax:360-427-2734
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC10023340376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA048952Medicaid