MEDICARE: STEPHANIE TERRELL NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP681A	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010152588	OTHER	ID	BLUE SHIELD
2	NPWJ2	OTHER	ID	BLUE CROSS
3	NPWK0	OTHER	ID	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000010152589	OTHER	ID	BLUE SHIELD

General Provider Information

NPI Number	:	1336127190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE TERRELL NP

Provider Business Mailing Address
First Line	:	2273 E GALA ST STE 110
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-7289
Country	:	US
Telephone Number	:	208-994-5700
Fax Number	:	208-288-4339

Provider Business Practice Location Address
First Line	:	2273 E GALA ST
Second Line	:	STE. 110
City	:	MERIDIAN
State	:	ID
Zip	:	83642-7289
Country	:	US
Telephone Number	:	208-995-4449
Fax Number	:	208-288-4339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	08/20/2013

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Directions to “ STEPHANIE TERRELL NP” Practice Location

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