Provider Demographics
NPI:1750136529
Name:GANSTER, TERYN
Entity type:Individual
Prefix:
First Name:TERYN
Middle Name:
Last Name:GANSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E. NORTH STREET PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:WEST UNITY
Mailing Address - State:OH
Mailing Address - Zip Code:43570
Mailing Address - Country:US
Mailing Address - Phone:567-287-1015
Mailing Address - Fax:
Practice Address - Street 1:14461 COUNTY ROAD C
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-9414
Practice Address - Country:US
Practice Address - Phone:567-287-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker