Healthcare Provider Details

I. General information

NPI: 1548284391
Provider Name (Legal Business Name): TERI LEE ROSSELLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2461 SW PERKINS AVE
PENDLETON OR
97801-4301
US

IV. Provider business mailing address

2461 SW PERKINS AVE
PENDLETON OR
97801-4301
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-0250
  • Fax: 541-276-0253
Mailing address:
  • Phone: 541-276-0250
  • Fax: 541-276-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30006540
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN00150128
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200350059NP
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number200350059NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: