Healthcare Provider Details

I. General information

NPI: 1003046681
Provider Name (Legal Business Name): TERRI ANN MCCORMICK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TERRI ANN JULIANO

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 HIGHLANDS DR SUITE 101
LITITZ PA
17543-7507
US

IV. Provider business mailing address

1575 HIGHLANDS DR SUITE 101
LITITZ PA
17543-7507
US

V. Phone/Fax

Practice location:
  • Phone: 717-393-1338
  • Fax: 717-293-4146
Mailing address:
  • Phone: 717-393-1338
  • Fax: 717-293-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN299382L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010052
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: