Provider Demographics
NPI:1093335887
Name:BUCK, TERREVIA LA SHAWN (RN)
Entity Type:Individual
Prefix:MS
First Name:TERREVIA
Middle Name:LA SHAWN
Last Name:BUCK
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 1:1423 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-2011
Mailing Address - Country:US
Mailing Address - Phone:323-920-4856
Mailing Address - Fax:323-451-8098
Practice Address - Street 1:1423 W 66TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-2011
Practice Address - Country:US
Practice Address - Phone:323-920-4856
Practice Address - Fax:323-451-8098
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN487145163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator