Provider Demographics
NPI:1043433766
Name:RASTOVAC, TERRIE LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TERRIE
Middle Name:LYNN
Last Name:RASTOVAC
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-2820
Mailing Address - Country:US
Mailing Address - Phone:717-838-2407
Mailing Address - Fax:
Practice Address - Street 1:913 E OAK ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-2820
Practice Address - Country:US
Practice Address - Phone:717-838-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN264132164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse