Provider Demographics
NPI:1447716659
Name:ROUSE, TERI RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:RENEE
Last Name:ROUSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6190 N SUNSHINE ST STE E
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8697
Mailing Address - Country:US
Mailing Address - Phone:208-719-0311
Mailing Address - Fax:208-719-0301
Practice Address - Street 1:6190 N SUNSHINE ST STE E
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8697
Practice Address - Country:US
Practice Address - Phone:208-719-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID60590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily