Individual
MRS. TERESA KAY FARRIS
Active
Individual
MRS. TERESA KAY FARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN-BC
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
209010009
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036115212
MEDICAID
IL
01
—
F400201342
MEDICARE INDIVIDUAL
IL
01
—
IL6310
MEDICARE GROUP
IL
Enumeration date
12/11/2012
Last updated
05/12/2017
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