Provider Demographics
NPI:1588980387
Name:CANFIELD, TERESA A
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:CANFIELD
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 1:106 W 3RD ST
Mailing Address - Street 2:SUITE 705
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5105
Mailing Address - Country:US
Mailing Address - Phone:716-484-7101
Mailing Address - Fax:716-484-7104
Practice Address - Street 1:106 W 3RD ST
Practice Address - Street 2:SUITE 705
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5105
Practice Address - Country:US
Practice Address - Phone:716-484-7101
Practice Address - Fax:716-484-7104
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY571834163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse