Healthcare Provider Details

I. General information

NPI: 1396018818
Provider Name (Legal Business Name): TERRI LYNN DOUGLAS MSN, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WEST AVE S
LA CROSSE WI
54601
US

IV. Provider business mailing address

800 WEST AVE S
LA CROSSE WI
54601-8806
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-3635
  • Fax:
Mailing address:
  • Phone: 715-838-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number170833
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 183302-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: