Healthcare Provider Details

I. General information

NPI: 1841628260
Provider Name (Legal Business Name): TERRA CATHERS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 08/13/2022
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 W BASELINE RD # 182-2273
PHOENIX AZ
85041-6574
US

IV. Provider business mailing address

2022 E GARY CIR
MESA AZ
85213-4608
US

V. Phone/Fax

Practice location:
  • Phone: 309-279-4162
  • Fax: 800-991-2996
Mailing address:
  • Phone: 309-279-4162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5192
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: