Provider Demographics
NPI:1497726467
Name:LOENDORF, TERYL A (MS, WHNP)
Entity Type:Individual
Prefix:
First Name:TERYL
Middle Name:A
Last Name:LOENDORF
Suffix:
Gender:F
Credentials:MS, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3933
Mailing Address - Country:US
Mailing Address - Phone:253-272-2718
Mailing Address - Fax:
Practice Address - Street 1:1515 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-3933
Practice Address - Country:US
Practice Address - Phone:253-272-2718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450074NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health