Provider Demographics
NPI:1073998332
Name:TERVOL, CATHERINE LEE (RN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:LEE
Last Name:TERVOL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ONSTED
Mailing Address - State:MI
Mailing Address - Zip Code:49265
Mailing Address - Country:US
Mailing Address - Phone:517-467-8247
Mailing Address - Fax:517-467-8247
Practice Address - Street 1:217 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ONSTED
Practice Address - State:MI
Practice Address - Zip Code:49265
Practice Address - Country:US
Practice Address - Phone:517-467-8247
Practice Address - Fax:517-467-8247
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704105859163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health