Provider Demographics
NPI:1669953717
Name:GEGNER, TERRI (LPN-IV)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:GEGNER
Suffix:
Gender:F
Credentials:LPN-IV
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN-IV
Mailing Address - Street 1:8195 W MILL ST APT 291
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-9028
Mailing Address - Country:US
Mailing Address - Phone:513-485-4088
Mailing Address - Fax:
Practice Address - Street 1:8195 W MILL ST APT 291
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-9028
Practice Address - Country:US
Practice Address - Phone:513-485-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.160159.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse