Individual
TERRIA CONWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5835 JESSICA AVE, PORTAGE, IN 46368-1662
(219) 628-5672
Mailing address
5835 JESSICA AVE, PORTAGE, IN 46368-1662
(219) 628-5672
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
IN
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300019795
—
IN
Enumeration date
01/01/2020
Last updated
07/21/2020
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