Provider Demographics
NPI:1538164538
Name:RICHARDS, TERESA A (CRNA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:A
Other - Last Name:CARUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:763 JOHNSONBURG ROAD
Mailing Address - Street 2:ERPG ANESTHESIA SERVICES
Mailing Address - City:ST. MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857
Mailing Address - Country:US
Mailing Address - Phone:814-788-8562
Mailing Address - Fax:814-788-8387
Practice Address - Street 1:763 JOHNSONBURG ROAD
Practice Address - Street 2:ERPG ANESTHESIA SERVICES
Practice Address - City:ST. MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857
Practice Address - Country:US
Practice Address - Phone:814-788-8562
Practice Address - Fax:814-788-8387
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA32295367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA32295OtherCRNA LICENSE NUMBER
PA101282013Medicaid
PA32295OtherCRNA LICENSE NUMBER
PAS22087Medicare UPIN