Provider Demographics
NPI:1700375243
Name:GIRT, TERRI (NP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:GIRT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6426 S 200 E
Mailing Address - Street 2:
Mailing Address - City:MARKLEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46056-9776
Mailing Address - Country:US
Mailing Address - Phone:765-620-8377
Mailing Address - Fax:
Practice Address - Street 1:7007 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4063
Practice Address - Country:US
Practice Address - Phone:317-559-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008006A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology