Healthcare Provider Details

I. General information

NPI: 1750769311
Provider Name (Legal Business Name): TERRA DENEB SCHAETZEL THORNDIKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST
TACOMA WA
98409-7264
US

IV. Provider business mailing address

300 1ST CAPITOL DR
SAINT CHARLES MO
63301-2844
US

V. Phone/Fax

Practice location:
  • Phone: 253-476-6500
  • Fax: 253-476-6547
Mailing address:
  • Phone: 636-947-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP03326
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD61154764
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2019001309
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: