Provider Demographics
NPI:1053306712
Name:NEAL, TERRY I (FNP-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:I
Last Name:NEAL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-1808
Mailing Address - Country:US
Mailing Address - Phone:260-563-2126
Mailing Address - Fax:260-563-2120
Practice Address - Street 1:276 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1808
Practice Address - Country:US
Practice Address - Phone:260-563-2126
Practice Address - Fax:260-563-2120
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008383363LP2300X
IN71000182363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000781881OtherANTHEM
IN200116740Medicaid
IN000000781881OtherANTHEM
INP22472Medicare UPIN