Provider Demographics
NPI:1841613148
Name:ROBERTS, TERRI (NP)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:ROBERTS
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:PO BOX 161
Mailing Address - Street 2:212 SOUTH 3RD STREET
Mailing Address - City:CORNELL
Mailing Address - State:WI
Mailing Address - Zip Code:54732
Mailing Address - Country:US
Mailing Address - Phone:715-202-3256
Mailing Address - Fax:
Practice Address - Street 1:2661 CTY HWY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:715-717-7485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI126389-30363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health