Healthcare Provider Details

I. General information

NPI: 1063579027
Provider Name (Legal Business Name): TERRY JEAN SCHRECKENGOST LPN NAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14179 NEW BUFFALO RD
COLUMBIANA OH
44408
US

IV. Provider business mailing address

1736 COUNTY LINE RD
MINERAL RIDGE OH
44440
US

V. Phone/Fax

Practice location:
  • Phone: 330-482-5426
  • Fax:
Mailing address:
  • Phone: 330-652-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN089047
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: