Provider Demographics
NPI:1932298866
Name:TERRELL, CARRIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:TERRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 24TH AVE S SUITE 300
Mailing Address - Street 2:RIVERSIDE PROF BLDG
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:55454
Mailing Address - Country:US
Mailing Address - Phone:612-273-7111
Mailing Address - Fax:612-273-7112
Practice Address - Street 1:606 24TH AVE S SUITE 300
Practice Address - Street 2:RIVERSIDE PROF BLDG
Practice Address - City:MPLS
Practice Address - State:MN
Practice Address - Zip Code:55454
Practice Address - Country:US
Practice Address - Phone:612-273-7111
Practice Address - Fax:612-273-7112
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40822207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN095968OtherFAIRVIEW
MN1020433OtherPREFERRED ONE
MN123579OtherUCARE
MT0062458Medicaid
MN07-00036OtherMEDICA PRIMARY
MN248J9TEOtherBLUE CROSS BLUE SHIELD
MN357724400Medicaid
MN07-02916OtherMEDICA CHOICE
MN852871OtherARAZ
MNHP28745OtherHEALTH PARTNERS
MN160001707Medicare ID - Type Unspecified
MN1020433OtherPREFERRED ONE