Healthcare Provider Details

I. General information

NPI: 1952887382
Provider Name (Legal Business Name): TERI LYN TOWNSEND DNP, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 KENYON RD
FORT DODGE IA
50501-5742
US

IV. Provider business mailing address

2704 22ND AVE N
FORT DODGE IA
50501-7324
US

V. Phone/Fax

Practice location:
  • Phone: 515-574-6855
  • Fax:
Mailing address:
  • Phone: 405-834-3286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberC151148
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: