Provider Demographics
NPI:1417691601
Name:HARRELL, TERENCE LAMONT
Entity Type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:LAMONT
Last Name:HARRELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12771 DAYBREAK CIR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-9507
Mailing Address - Country:US
Mailing Address - Phone:757-725-1998
Mailing Address - Fax:
Practice Address - Street 1:12771 DAYBREAK CIR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-9507
Practice Address - Country:US
Practice Address - Phone:757-725-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)