Provider Demographics
NPI:1912360546
Name:TERWILLIGER, MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TERWILLIGER
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 1:1100 JOLIET ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1996
Mailing Address - Country:US
Mailing Address - Phone:219-836-2096
Mailing Address - Fax:219-836-2097
Practice Address - Street 1:1100 JOLIET ST
Practice Address - Street 2:SUITE 201
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1996
Practice Address - Country:US
Practice Address - Phone:219-836-2096
Practice Address - Fax:219-836-2097
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28141768A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily