Basic Information
| Provider Information | |||||||||
| NPI: | 1235166323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURRELL | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CNM, PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 32ND AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581036132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013648000 | ||||||||
| FaxNumber: | 7013648078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 08/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | R20970 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | HP25721 | 01 | ND | HEALTHPARTNERS # | OTHER | 9D421BU | 01 | ND | MNBS # | OTHER | ND200077 | 01 | ND | LHS # | OTHER | 12070 | 01 | ND | NDBS # | OTHER | DA9011015515 | 01 | ND | PREFERRED ONE # | OTHER | 142324 | 01 | ND | UCARE # | OTHER | 19500 | 05 | ND | MEDICAID | 569740900 | 05 | ND | MEDICAID | 0701575 | 01 | ND | MEDICA # | OTHER | 0702337 | 01 | ND | MEDICA # | OTHER | 900339 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | 9D420BU | 01 | ND | MNBS # | OTHER |