Provider Demographics
NPI:1346230125
Name:HEIDENREITER, TERRENCE JOHN (RNC)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:JOHN
Last Name:HEIDENREITER
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Gender:M
Credentials:RNC
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Mailing Address - Street 1:2480 LLEWELLYN AVE
Mailing Address - Street 2:ATTN: MCXR-CR KIMBROUGH AMBULATORY CARE CENTER
Mailing Address - City:FT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-5800
Mailing Address - Country:US
Mailing Address - Phone:301-677-8270
Mailing Address - Fax:301-677-8176
Practice Address - Street 1:2480 LLEWELLYN AVE
Practice Address - Street 2:RED TEAM
Practice Address - City:FT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5800
Practice Address - Country:US
Practice Address - Phone:301-677-8949
Practice Address - Fax:301-677-8499
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR152573363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health