Provider Demographics
NPI:1457666711
Name:DEFOE, TERRY ANN (RN)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ANN
Last Name:DEFOE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 BURNING TREE RD
Mailing Address - Street 2:#100
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3800
Mailing Address - Country:US
Mailing Address - Phone:218-733-0707
Mailing Address - Fax:
Practice Address - Street 1:4815 BURNING TREE RD
Practice Address - Street 2:#100
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-3800
Practice Address - Country:US
Practice Address - Phone:218-733-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN192068-4163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management