Provider Demographics
NPI:1083319073
Name:UNDERWOOD, TERRICITA
Entity type:Individual
Prefix:
First Name:TERRICITA
Middle Name:
Last Name:UNDERWOOD
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 1:1298 E AVENIDA ISABELA
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-1020
Mailing Address - Country:US
Mailing Address - Phone:775-303-0877
Mailing Address - Fax:
Practice Address - Street 1:1298 E AVENIDA ISABELA
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-1020
Practice Address - Country:US
Practice Address - Phone:775-303-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist