Provider Demographics
NPI:1710318852
Name:TERRELL, ELIZABETH L (LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 HICKMAN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4305
Mailing Address - Country:US
Mailing Address - Phone:515-331-8948
Mailing Address - Fax:515-331-6681
Practice Address - Street 1:8230 HICKMAN RD
Practice Address - Street 2:SUITE B
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4305
Practice Address - Country:US
Practice Address - Phone:515-331-8948
Practice Address - Fax:515-331-6681
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist