Provider Demographics
NPI:1295728244
Name:DOUGLASS, TERRY ELIZABETH (ARNP, PHD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ELIZABETH
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:ARNP, PHD
Other - Prefix:DR
Other - First Name:THERESSE
Other - Middle Name:ELIZABETH
Other - Last Name:DOUGLASS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP, PHD
Mailing Address - Street 1:6863 EAGLE HARBOR DR NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3103
Mailing Address - Country:US
Mailing Address - Phone:206-660-6199
Mailing Address - Fax:206-238-9777
Practice Address - Street 1:6863 EAGLE HARBOR DR NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3103
Practice Address - Country:US
Practice Address - Phone:260-660-6199
Practice Address - Fax:206-238-9777
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2014-11-14
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
WAAP30000194163WP0807X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9605122Medicaid
WA9605122Medicaid
GAB09752Medicare PIN