Provider Demographics
NPI:1972610673
Name:TERESI, CAROL LYNN (NP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LYNN
Last Name:TERESI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 BYLLESBY AVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335
Mailing Address - Country:US
Mailing Address - Phone:814-460-4946
Mailing Address - Fax:814-860-2116
Practice Address - Street 1:135 E 38TH ST
Practice Address - Street 2:ERIE VAMC BEHAVIORAL HEALTH
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504
Practice Address - Country:US
Practice Address - Phone:814-860-2038
Practice Address - Fax:814-860-2116
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA264739L163W00000X
PATP005824B164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse