Provider Demographics
NPI:1124594650
Name:TERRY, VANIA
Entity type:Individual
Prefix:
First Name:VANIA
Middle Name:
Last Name:TERRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:VANIA
Other - Middle Name:
Other - Last Name:IBACACHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 LORIS RD
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1802
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 LORIS RD
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1802
Practice Address - Country:US
Practice Address - Phone:781-856-5083
Practice Address - Fax:781-856-5083
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2282448363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care