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Individual
MRS. TERRI TONISHA VAN DORN
Active
Individual
MRS. TERRI TONISHA VAN DORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP (ACNP-BC)
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN195252
GA
363LA2100X
Acute Care Nurse Practitioner
RN195252
GA
363LA2200X
Adult Health Nurse Practitioner
RN195252
GA
Other
Enumeration date
12/11/2012
Last updated
10/27/2014
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