Provider Demographics
NPI:1972067601
Name:TERRANOVA, JOHN ROBERT (LPN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:TERRANOVA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 1ST AVE APT 1003
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2139
Mailing Address - Country:US
Mailing Address - Phone:401-447-0775
Mailing Address - Fax:
Practice Address - Street 1:1116 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2831
Practice Address - Country:US
Practice Address - Phone:202-206-3230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2021-07-08
Deactivation Date:2021-06-17
Deactivation Code:
Reactivation Date:2021-07-08
Provider Licenses
StateLicense IDTaxonomies
WALP60909291164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse