Provider Demographics
NPI:1295954048
Name:KLUG, TERRY LEE (LPN)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:KLUG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7824 APPLETREE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-3613
Mailing Address - Country:US
Mailing Address - Phone:410-360-7089
Mailing Address - Fax:
Practice Address - Street 1:3801 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2026
Practice Address - Country:US
Practice Address - Phone:410-222-6460
Practice Address - Fax:410-222-6498
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP15220164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse