Basic Information
| Provider Information | |||||||||
| NPI: | 1285275966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROWE | ||||||||
| FirstName: | TERIN | ||||||||
| MiddleName: | JADE | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 HORNBEAM RD | ||||||||
| Address2: | |||||||||
| City: | SABINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451698011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377289050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1510 COLUMBUS AVE STE 230 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON COURT HOUSE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431601987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403333333 | ||||||||
| FaxNumber: | 7403335171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2019 | ||||||||
| LastUpdateDate: | 07/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.025697 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0375296 | 05 | OH | MEDICAID |