Healthcare Provider Details

I. General information

NPI: 1871079624
Provider Name (Legal Business Name): BRITTANY L TERPSTRA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY L HOOVER

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W BARNEY ST
GOUVERNEUR NY
13642-1040
US

IV. Provider business mailing address

4 COMMERCE LANE
CANTON NY
13617-3739
US

V. Phone/Fax

Practice location:
  • Phone: 315-287-4440
  • Fax: 315-287-1858
Mailing address:
  • Phone: 315-386-8191
  • Fax: 315-386-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number022109
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: