Provider Demographics
NPI:1386944098
Name:CORMIER, TEASA L
Entity type:Individual
Prefix:
First Name:TEASA
Middle Name:L
Last Name:CORMIER
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 1:23019 GOOD DALE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-7009
Mailing Address - Country:US
Mailing Address - Phone:832-721-1918
Mailing Address - Fax:
Practice Address - Street 1:505 CYPRESS STATION DR APT 1808
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1616
Practice Address - Country:US
Practice Address - Phone:832-721-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization