=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427178599
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERRY JAY PEURA CRNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 01/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 795 E LANCASTER AVE STE 210
-----------------------------------------------------
City | VILLANOVA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19085-1525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-254-6000
-----------------------------------------------------
Fax | 215-754-1705
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 807 S PROVIDENCE RD
-----------------------------------------------------
City | WALLINGFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19086-7213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-874-4403
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | TP004910D
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | TP004910D
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | TP004910D
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------