Provider Demographics
NPI:1902484199
Name:MCQUISTAN, TERESA ANN
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:MCQUISTAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 W GRANT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-1925
Mailing Address - Country:US
Mailing Address - Phone:541-401-8580
Mailing Address - Fax:
Practice Address - Street 1:33125 SE WHITE OAK RD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2557
Practice Address - Country:US
Practice Address - Phone:541-401-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant