Provider Demographics
NPI:1093706194
Name:WARD, TERRIE LEE VANN (NP)
Entity Type:Individual
Prefix:MS
First Name:TERRIE
Middle Name:LEE VANN
Last Name:WARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 WESTWOOD RD NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LK PK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-1319
Mailing Address - Country:US
Mailing Address - Phone:847-606-3303
Mailing Address - Fax:
Practice Address - Street 1:8300 WESTWOOD RD NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-1319
Practice Address - Country:US
Practice Address - Phone:847-606-3303
Practice Address - Fax:847-267-0979
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA139556363L00000X
IL209004798363LF0000X
IL209-004798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1871151Medicare PIN