Provider Demographics
NPI:1104892140
Name:TERRY, PATRICIA A (NP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:TERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 730
Mailing Address - Street 2:406 E ELM ST
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811
Mailing Address - Country:US
Mailing Address - Phone:989-584-3131
Mailing Address - Fax:989-584-6734
Practice Address - Street 1:102 S THIRD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811
Practice Address - Country:US
Practice Address - Phone:989-584-1308
Practice Address - Fax:989-584-0307
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704169723363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00700259OtherRAILROAD MEDICARE
MI4385156Medicaid
MIP00700259OtherRAILROAD MEDICARE
MION13030Medicare PIN