Provider Demographics
NPI:1609958511
Name:NORMAN, TERIL H (APN)
Entity Type:Individual
Prefix:
First Name:TERIL
Middle Name:H
Last Name:NORMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6880 S MCCARRAN BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6129
Mailing Address - Country:US
Mailing Address - Phone:775-828-2333
Mailing Address - Fax:775-828-2344
Practice Address - Street 1:6880 S MCCARRAN BLVD STE 5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6129
Practice Address - Country:US
Practice Address - Phone:775-828-2333
Practice Address - Fax:775-828-2344
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000800363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
100170Medicare ID - Type Unspecified
Q34442Medicare UPIN