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  7. NPI Record 1235166323

TERRY J BURRELL CNM, PHD
Complete NPI Record 1235166323
Advanced Practice Midwife in Fargo, ND

NPI Status: Active since June 26, 2006

Contact Information

3000 32ND AVE S
FARGO, ND
ZIP 58103
Phone: (701) 364-8000
Fax: (701) 364-8078

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Credential Text
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Provider Gender Code
  24. Healthcare Provider Taxonomy Code 1
  25. Provider License Number 1
  26. Provider License Number State Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Other Provider Identifier 1
  29. Other Provider Identifier Type Code 1
  30. Other Provider Identifier State 1
  31. Other Provider Identifier Issuer 1
  32. Other Provider Identifier 2
  33. Other Provider Identifier Type Code 2
  34. Other Provider Identifier State 2
  35. Other Provider Identifier Issuer 2
  36. Other Provider Identifier 3
  37. Other Provider Identifier Type Code 3
  38. Other Provider Identifier State 3
  39. Other Provider Identifier Issuer 3
  40. Other Provider Identifier 4
  41. Other Provider Identifier Type Code 4
  42. Other Provider Identifier State 4
  43. Other Provider Identifier Issuer 4
  44. Other Provider Identifier 5
  45. Other Provider Identifier Type Code 5
  46. Other Provider Identifier State 5
  47. Other Provider Identifier Issuer 5
  48. Other Provider Identifier 6
  49. Other Provider Identifier Type Code 6
  50. Other Provider Identifier State 6
  51. Other Provider Identifier 7
  52. Other Provider Identifier Type Code 7
  53. Other Provider Identifier State 7
  54. Other Provider Identifier 8
  55. Other Provider Identifier Type Code 8
  56. Other Provider Identifier State 8
  57. Other Provider Identifier Issuer 8
  58. Other Provider Identifier 9
  59. Other Provider Identifier Type Code 9
  60. Other Provider Identifier State 9
  61. Other Provider Identifier Issuer 9
  62. Other Provider Identifier 10
  63. Other Provider Identifier Type Code 10
  64. Other Provider Identifier State 10
  65. Other Provider Identifier Issuer 10
  66. Other Provider Identifier 11
  67. Other Provider Identifier Type Code 11
  68. Other Provider Identifier State 11
  69. Other Provider Identifier Issuer 11
  70. Other Provider Identifier 12
  71. Other Provider Identifier Type Code 12
  72. Other Provider Identifier State 12
  73. Other Provider Identifier Issuer 12
  74. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1235166323. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1235166323
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: TERRY
The first name of the provider, if the provider is an individual.
Provider Middle Name: J
The middle name of the provider, if the provider is an individual.
Provider Credential Text: CNM, PHD
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: PO BOX 6001
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: FARGO
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: ND
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 581086001
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7013643300
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 7013648906
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 3000 32ND AVE S
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: FARGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: ND
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 581036132
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7013648000
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 7013648078
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 6/26/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/17/2011
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 367A00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: R20970
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: ND
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Other Provider Identifier 1: ND200077
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: ND
Other Provider Identifier Issuer 1: LHS #
Other Provider Identifier 2: 0702337
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: ND
Other Provider Identifier Issuer 2: MEDICA #
Other Provider Identifier 3: 900339
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: ND
Other Provider Identifier Issuer 3: AMERICA'S PPO/ARAZ #
Other Provider Identifier 4: 12070
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: ND
Other Provider Identifier Issuer 4: NDBS #
Other Provider Identifier 5: 142324
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: ND
Other Provider Identifier Issuer 5: UCARE #
Other Provider Identifier 6: 569740900
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: ND
Other Provider Identifier 7: 19500
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: ND
Other Provider Identifier 8: HP25721
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: ND
Other Provider Identifier Issuer 8: HEALTHPARTNERS #
Other Provider Identifier 9: 0701575
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: ND
Other Provider Identifier Issuer 9: MEDICA #
Other Provider Identifier 10: 9D420BU
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: ND
Other Provider Identifier Issuer 10: MNBS #
Other Provider Identifier 11: 9D421BU
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: ND
Other Provider Identifier Issuer 11: MNBS #
Other Provider Identifier 12: DA9011015515
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: ND
Other Provider Identifier Issuer 12: PREFERRED ONE #
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No