Provider Demographics
NPI:1831225994
Name:STOWELL, TERRY SUE
Entity type:Individual
Prefix:MS
First Name:TERRY
Middle Name:SUE
Last Name:STOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TERESA
Other - Middle Name:SUE
Other - Last Name:KIERNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS RD CD
Mailing Address - Street 1:522 SILVER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6226
Mailing Address - Country:US
Mailing Address - Phone:925-820-5639
Mailing Address - Fax:925-820-1459
Practice Address - Street 1:522 SILVER LAKE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-6226
Practice Address - Country:US
Practice Address - Phone:925-683-0321
Practice Address - Fax:925-820-5639
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA727684133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB29273Medicare ID - Type Unspecified