Provider Demographics
NPI:1457846206
Name:MEADOWS, TERI ANN (DNP)
Entity Type:Individual
Prefix:MRS
First Name:TERI
Middle Name:ANN
Last Name:MEADOWS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4933 N SUNDERLAND DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-2263
Mailing Address - Country:US
Mailing Address - Phone:208-869-2630
Mailing Address - Fax:
Practice Address - Street 1:520 S EAGLE RD STE 3211
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6356
Practice Address - Country:US
Practice Address - Phone:208-706-5930
Practice Address - Fax:208-706-5942
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID34318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner