Healthcare Provider Details

I. General information

NPI: 1295728244
Provider Name (Legal Business Name): TERRY ELIZABETH DOUGLASS ARNP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESSE ELIZABETH DOUGLASS ARNP, PHD

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

6863 EAGLE HARBOR DR NE
BAINBRIDGE ISLAND WA
98110-3103
US

IV. Provider business mailing address

6863 EAGLE HARBOR DR NE
BAINBRIDGE ISLAND WA
98110-3103
US

V. Phone/Fax

Practice location:
  • Phone: 260-660-6199
  • Fax: 206-238-9777
Mailing address:
  • Phone: 206-660-6199
  • Fax: 206-238-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberAP30000194
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberAP30000194
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: