Provider Demographics
NPI:1982971016
Name:GEIS, TERESA D (CRNA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:GEIS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173
Mailing Address - Country:US
Mailing Address - Phone:765-932-4111
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:1300 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173
Practice Address - Country:US
Practice Address - Phone:765-932-4111
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28133942A163W00000X, 367500000X
KY088857367500000X
OH344911163W00000X
KY1119717163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0062877Medicaid
00001124000OtherBUREAU OF WORKERS COMPENSATION
IN201058010Medicaid
KY7100188260Medicaid
KYK044680Medicare PIN
KYP01034548Medicare PIN