Provider Demographics
NPI:1881083111
Name:TERPACK, TERESA (LPN)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:TERPACK
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 1:27 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-1441
Mailing Address - Country:US
Mailing Address - Phone:412-849-5212
Mailing Address - Fax:
Practice Address - Street 1:27 SUNNYSIDE AVE
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-1441
Practice Address - Country:US
Practice Address - Phone:412-849-5212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider