Provider Demographics
NPI:1326437062
Name:TERSEA TRAVIS
Entity Type:Organization
Organization Name:TERSEA TRAVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOULA
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-427-3372
Mailing Address - Street 1:PSC 80 BOX 12587
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0028
Mailing Address - Country:US
Mailing Address - Phone:313-427-3372
Mailing Address - Fax:
Practice Address - Street 1:PSC 80 BOX 12587
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96367-0028
Practice Address - Country:US
Practice Address - Phone:313-427-3372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty