Provider Demographics
NPI:1811717630
Name:TERRY, ELAINE MARIE (FNP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:TERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 S ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4113
Mailing Address - Country:US
Mailing Address - Phone:775-329-6300
Mailing Address - Fax:
Practice Address - Street 1:5055 SUN VALLEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89433-8296
Practice Address - Country:US
Practice Address - Phone:775-329-6300
Practice Address - Fax:775-348-3896
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN884597363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily