Basic Information
| Provider Information | |||||||||
| NPI: | 1174697882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEANE-DAUWALDER | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2710 GATEWAY OAKS DR # 360 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958333505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166462770 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2710 GATEWAY OAKS DR # 360 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958333505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166462770 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 06/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 13239 | CA | N | Nursing Service Providers | Registered Nurse | 363L00000X | 13239 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 13239 | 01 | CA | LICENSE | OTHER |