Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71000182 | IN |
N | 363LP2300X | Nurse Practitioner - Primary Care | 71008383 | IN |
NPI | 1053306712 |
---|---|
Provider Name | Terry I Neal |
First Address | Marion, IN 46952-3415 |
Second Address | Marion, IN 46952-3415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000781881 | ANTHEM (01) | IN |
200116740 | (05) | IN |