Provider Demographics
NPI:1356705982
Name:SCULLY, TERRI M (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:M
Last Name:SCULLY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2807
Mailing Address - Country:US
Mailing Address - Phone:281-543-0134
Mailing Address - Fax:
Practice Address - Street 1:4703 RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2807
Practice Address - Country:US
Practice Address - Phone:281-543-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-10
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX805149163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant