Provider Demographics
NPI:1730497785
Name:ZACHARIAS, TERRY MARIE (FNP-BC, APNP)
Entity Type:Individual
Prefix:MS
First Name:TERRY
Middle Name:MARIE
Last Name:ZACHARIAS
Suffix:
Gender:F
Credentials:FNP-BC, APNP
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Other - First Name:
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Mailing Address - Street 1:W180N8085 TOWN HALL RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-3518
Mailing Address - Country:US
Mailing Address - Phone:262-251-1000
Mailing Address - Fax:262-518-5052
Practice Address - Street 1:W180N8085 TOWN HALL RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051
Practice Address - Country:US
Practice Address - Phone:262-251-1000
Practice Address - Fax:262-518-5052
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4176-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1730497785Medicaid