Provider Demographics
NPI:1184345373
Name:GRAYBEAL, TERYL (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:TERYL
Middle Name:
Last Name:GRAYBEAL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 PINE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1344
Mailing Address - Country:US
Mailing Address - Phone:503-910-6862
Mailing Address - Fax:
Practice Address - Street 1:1418 PINE ST UNIT 1
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1344
Practice Address - Country:US
Practice Address - Phone:503-910-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-17211163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant