Provider Demographics
NPI:1689142713
Name:SHOEMAKER, TERRI JO (CRNP)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:JO
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:JO
Other - Last Name:AIKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:
Practice Address - Street 1:12560 STATE ROUTE 405
Practice Address - Street 2:
Practice Address - City:WATSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17777-8525
Practice Address - Country:US
Practice Address - Phone:570-538-2501
Practice Address - Fax:570-538-3227
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN586700163W00000X
PASP019352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty