Provider Demographics
NPI:1194339317
Name:TESTERMAN, AOIBHEANN FALLOW
Entity type:Individual
Prefix:
First Name:AOIBHEANN
Middle Name:FALLOW
Last Name:TESTERMAN
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 1:9805 ROCKY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8922
Mailing Address - Country:US
Mailing Address - Phone:704-494-3466
Mailing Address - Fax:
Practice Address - Street 1:9805 ROCKY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-8922
Practice Address - Country:US
Practice Address - Phone:704-494-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013512363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily