Provider Demographics
NPI:1285275966
Name:ROWE, TERIN JADE (CNP)
Entity type:Individual
Prefix:
First Name:TERIN
Middle Name:JADE
Last Name:ROWE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 HORNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:SABINA
Mailing Address - State:OH
Mailing Address - Zip Code:45169-8011
Mailing Address - Country:US
Mailing Address - Phone:937-728-9050
Mailing Address - Fax:
Practice Address - Street 1:1510 COLUMBUS AVE STE 230
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1987
Practice Address - Country:US
Practice Address - Phone:740-333-3333
Practice Address - Fax:740-333-5171
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0375296Medicaid