Provider Demographics
NPI:1720319940
Name:TERESCHUK-PHILLIPS, ANASTASIA
Entity type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:
Last Name:TERESCHUK-PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANASTASIA
Other - Middle Name:MIKEL
Other - Last Name:TERESCHUK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN ACNP-BC PMHNP-BC
Mailing Address - Street 1:425 W SANILAC RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1072
Mailing Address - Country:US
Mailing Address - Phone:615-509-2664
Mailing Address - Fax:
Practice Address - Street 1:425 W SANILAC RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1072
Practice Address - Country:US
Practice Address - Phone:615-509-2664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN157417163W00000X
MECNP191044363LP0808X
FLAPRN11017928363LP0808X
KY3014541363LP0808X
MI4704300715363LP0808X
NH087547-23363LP0808X
TN14696363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1031505037OtherMEDICARE
TN1518627Medicaid
TN103I509091Medicare PIN