Provider Demographics
NPI:1467242115
Name:TERRELL, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:TERRELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5080 E BILL FARR DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-9324
Mailing Address - Country:US
Mailing Address - Phone:812-478-1825
Mailing Address - Fax:
Practice Address - Street 1:5080 E BILL FARR DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9324
Practice Address - Country:US
Practice Address - Phone:812-478-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28141858A163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care