Provider Demographics
NPI:1548492879
Name:SCHUETZ, TERRI L (ANP-BC)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:SCHUETZ
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 337
Mailing Address - Street 2:
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-0337
Mailing Address - Country:US
Mailing Address - Phone:304-469-2905
Mailing Address - Fax:304-465-5486
Practice Address - Street 1:302 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOPHIA
Practice Address - State:WV
Practice Address - Zip Code:25921-1283
Practice Address - Country:US
Practice Address - Phone:304-683-3809
Practice Address - Fax:304-683-5761
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46087363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810019564Medicaid
WV2034753Medicare PIN
WV3810019564Medicaid