Provider Demographics
NPI:1225605876
Name:MCCRORY, TERRA
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:MCCRORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RINGNECK TRL
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-4999
Mailing Address - Country:US
Mailing Address - Phone:574-527-0270
Mailing Address - Fax:
Practice Address - Street 1:400 RINGNECK TRL
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4999
Practice Address - Country:US
Practice Address - Phone:574-527-0270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28210785A364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care