Individual
OLGA MIKHAYLOVNA TER-GRIGORYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3500 TOWER AVE, SUPERIOR, WI 54880-5335
(715) 395-5454
Mailing address
3500 TOWER AVE, SUPERIOR, WI 54880-5335
(715) 395-5454
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
15318-30
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36005400
—
WI
Enumeration date
08/08/2006
Last updated
04/29/2011
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