Provider Demographics
NPI:1285150177
Name:GAZDIG, TERRI LYNN
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:GAZDIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:LYNN
Other - Last Name:SPEIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:USGG JUNEAU MEDICAL CLINIC 709 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-463-2104
Mailing Address - Fax:907-463-2150
Practice Address - Street 1:USGG JUNEAU MEDICAL CLINIC, 709 W 9TH ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1807
Practice Address - Country:US
Practice Address - Phone:907-463-2104
Practice Address - Fax:907-463-2150
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK34671163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice