Provider Demographics
NPI:1891205209
Name:TERRELL, TERRIE LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERRIE
Middle Name:LYNN
Last Name:TERRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-9228
Mailing Address - Country:US
Mailing Address - Phone:405-706-8212
Mailing Address - Fax:
Practice Address - Street 1:5713 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-9228
Practice Address - Country:US
Practice Address - Phone:405-706-8212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32079163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse