1477822005 NPI number — MRS. MICHELLE FUREY TERWILLIGER RN

Table of content: MRS. MICHELLE FUREY TERWILLIGER RN (NPI 1477822005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477822005 NPI number — MRS. MICHELLE FUREY TERWILLIGER RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TERWILLIGER
Provider First Name:
MICHELLE
Provider Middle Name:
FUREY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1477822005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1432 ADDISON BACK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14801-9338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-359-4981
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 STATE ROUTE 36
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROUPSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-525-6301
Provider Business Practice Location Address Fax Number:
607-525-6309
Provider Enumeration Date:
12/28/2011

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: 163W00000X , with the licence number:  502415 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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