Basic Information
Provider Information
NPI: 1396799490
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALDERSON
FirstName: TERRI
MiddleName: LEE
NamePrefix: MS.
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1970 ROANOKE BLVD
Address2:  
City: SALEM
State: VA
PostalCode: 241536404
CountryCode: US
TelephoneNumber: 5404271229
FaxNumber: 5402241958
Practice Location
Address1: 1970 ROANOKE BLVD
Address2:  
City: SALEM
State: VA
PostalCode: 241536404
CountryCode: US
TelephoneNumber: 5409822463
FaxNumber: 5402241958
Other Information
ProviderEnumerationDate: 05/22/2006
LastUpdateDate: 06/28/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X0017138433VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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