Provider Demographics
NPI:1063579027
Name:SCHRECKENGOST, TERRY JEAN (LPN NAP)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:JEAN
Last Name:SCHRECKENGOST
Suffix:
Gender:F
Credentials:LPN NAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440
Mailing Address - Country:US
Mailing Address - Phone:330-652-2908
Mailing Address - Fax:
Practice Address - Street 1:14179 NEW BUFFALO RD
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408
Practice Address - Country:US
Practice Address - Phone:330-482-5426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN089047164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2290613OtherPRIVATE PROVIDER
OHPN089047OtherLPN