Provider Demographics
NPI:1699882621
Name:VANDENHOUTEN, TERRI L (APNP)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:L
Last Name:VANDENHOUTEN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:4070 EQUESTRIAN RD
Practice Address - Street 2:
Practice Address - City:NEW FRANKIN
Practice Address - State:WI
Practice Address - Zip Code:54229
Practice Address - Country:US
Practice Address - Phone:920-866-6100
Practice Address - Fax:920-468-2428
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84029-030363L00000X
WI488-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner