Individual
STEPHANIE TERRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2273 E GALA ST, STE. 110, MERIDIAN, ID 83642-7289
(208) 995-4449
(208) 288-4339
Mailing address
2273 E GALA ST STE 110, MERIDIAN, ID 83642-7289
(208) 994-5700
(208) 288-4339
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP681A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152588
BLUE SHIELD
ID
01
—
000010152589
BLUE SHIELD
ID
05
—
807287100
—
ID
01
—
NPWJ2
BLUE CROSS
ID
01
—
NPWK0
BLUE CROSS
ID
Enumeration date
01/03/2006
Last updated
08/20/2013
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