Provider Demographics
NPI:1003282658
Name:TERRELL, PHD, RN., GLADYS L. L (PHD, NUTRITION , RN)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS L.
Middle Name:L
Last Name:TERRELL, PHD, RN.
Suffix:
Gender:F
Credentials:PHD, NUTRITION , RN
Other - Prefix:
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Mailing Address - Street 1:1012 SUMMERCREST CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1581
Mailing Address - Country:US
Mailing Address - Phone:615-653-1272
Mailing Address - Fax:615-653-1272
Practice Address - Street 1:1012 SUMMERCREST CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-1581
Practice Address - Country:US
Practice Address - Phone:615-653-1272
Practice Address - Fax:615-653-1272
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALPHD133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRN0000028783OtherTENN. CODE ANNOTATED