Basic Information
| Provider Information | |||||||||
| NPI: | 1982602751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEEGE | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WENNERSTEN | ||||||||
| OtherFirstName: | TERRY | ||||||||
| OtherMiddleName: | L. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | N10565 GRANDVIEW LANE | ||||||||
| Address2: | |||||||||
| City: | IRONWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499389622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9069321500 | ||||||||
| FaxNumber: | 9069325091 | ||||||||
| Practice Location | |||||||||
| Address1: | N10565 GRANDVIEW LANE | ||||||||
| Address2: | |||||||||
| City: | IRONWOOD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499389622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9069321500 | ||||||||
| FaxNumber: | 9069325091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 05/27/2010 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 4704148492 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363L00000X | 4704148492 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1029609 | 01 | PREFERREDONE | OTHER | 4354089 | 05 | MI | MEDICAID | 12D89WE | 01 | MN | BCBS | OTHER | 43901600 | 05 | WI | MEDICAID | 50-0-87-5391-0 | 01 | MI | BCBS | OTHER | 500875391 | 01 | MI | BCBS | OTHER |