Provider Demographics
NPI:1508237843
Name:OWSLEY, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:OWSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1657 E LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-8248
Mailing Address - Country:US
Mailing Address - Phone:602-821-1807
Mailing Address - Fax:
Practice Address - Street 1:1657 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-8248
Practice Address - Country:US
Practice Address - Phone:602-821-1807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ39920003172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker