Healthcare Provider Details

I. General information

NPI: 1295266468
Provider Name (Legal Business Name): YVONNE J TERRELL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 UPPER MOUNTAIN AVE
MONTCLAIR NJ
07043-1415
US

IV. Provider business mailing address

435 UPPER MOUNTAIN AVE
MONTCLAIR NJ
07043-1415
US

V. Phone/Fax

Practice location:
  • Phone: 973-783-3806
  • Fax:
Mailing address:
  • Phone: 973-783-3806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00712000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NJ00712000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: