Provider Demographics
NPI:1972352219
Name:IRVIN, TERESA OLIVER
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:OLIVER
Last Name:IRVIN
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 1:2714 QUAIL OAKS DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-2958
Mailing Address - Country:US
Mailing Address - Phone:336-894-0202
Mailing Address - Fax:
Practice Address - Street 1:2714 QUAIL OAKS DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-2958
Practice Address - Country:US
Practice Address - Phone:336-894-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician