Provider Demographics
NPI:1811284896
Name:TEELE, ROSALIE BEACHER (LPN)
Entity type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:BEACHER
Last Name:TEELE
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 1:1770 TUFTSTOWN CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2588
Mailing Address - Country:US
Mailing Address - Phone:770-733-0905
Mailing Address - Fax:
Practice Address - Street 1:1770 TUFTSTOWN CT
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2588
Practice Address - Country:US
Practice Address - Phone:770-733-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN070131164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse