Individual
TERESA C RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3075 N RESERVE ST STE Q, MISSOULA, MT 59808-1390
(406) 327-1850
(406) 327-1875
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(406) 327-1850
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-98860
MT
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17786746
—
CO
Enumeration date
09/16/2013
Last updated
11/10/2021
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