Provider Demographics
NPI:1164770855
Name:TERHAAR, AMY S (ARNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:TERHAAR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 DAWES DR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4112
Mailing Address - Country:US
Mailing Address - Phone:515-441-0209
Mailing Address - Fax:475-477-0531
Practice Address - Street 1:99 HAWLEY LN
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1202
Practice Address - Country:US
Practice Address - Phone:203-666-8145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAL114360363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner