Provider Demographics
NPI:1215044235
Name:DENNIS, TERRI (NP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:MCLIVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5943 STADIUM DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 S US 131
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093
Practice Address - Country:US
Practice Address - Phone:269-286-7070
Practice Address - Fax:269-286-7071
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704213605363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P86848Medicare UPIN