Provider Demographics
NPI:1699538991
Name:MCCASLAND, TEPPI (LPN)
Entity type:Individual
Prefix:
First Name:TEPPI
Middle Name:
Last Name:MCCASLAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 S 157TH AVE # AVD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3357
Mailing Address - Country:US
Mailing Address - Phone:623-772-4610
Mailing Address - Fax:
Practice Address - Street 1:2131 S 157TH AVE # AVD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3357
Practice Address - Country:US
Practice Address - Phone:623-772-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP036948164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse