1265543748 NPI number — TERRY LANE TERPSTRA RN, MSN

Table of content: TERRY LANE TERPSTRA RN, MSN (NPI 1265543748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265543748 NPI number — TERRY LANE TERPSTRA RN, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERPSTRA
Provider First Name:
TERRY
Provider Middle Name:
LANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265543748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
52231 PINE TREE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THREE RIVERS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49093-9759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-273-8937
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 ARMSTRONG RD
Provider Second Line Business Practice Location Address:
BUILDING 83 ROOM 249
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49015-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-966-5600
Provider Business Practice Location Address Fax Number:
269-660-5001
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  4704188306 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)