Provider Demographics
NPI:1902154644
Name:TETER, DONIELLE SUZANNE (NP-C)
Entity Type:Individual
Prefix:
First Name:DONIELLE
Middle Name:SUZANNE
Last Name:TETER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0247
Mailing Address - Country:US
Mailing Address - Phone:304-335-2050
Mailing Address - Fax:304-335-6158
Practice Address - Street 1:US RT 219/250
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WV
Practice Address - Zip Code:26280-0247
Practice Address - Country:US
Practice Address - Phone:304-335-2050
Practice Address - Fax:304-335-6158
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily