TERENCE SHAUN EDGAR (NPI# 1679506091) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679506091 |
| Entity Type | Individual |
| Full Name | TERENCE SHAUN EDGAR |
| Credential | MD |
| Practice Address |
1821 S Webster Ave Green Bay WI 54301-2253 |
| Mailing Address |
Po Box 19070 Green Bay WI 54307-9070 |
| Practice Telephone | 9204964700 |
| Mailing Telephone | 9204964700 |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2014-07-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
52201 | MN | Allopathic & Osteopathic Physicians |
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
34917 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | ENROLLED | 05 | |
| IA | ENROLLED | 05 | |
| WI | 32117600 | 05 |
| Street Address |
1821 S WEBSTER AVE |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54301-2253 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821091679 | Jerald P Marifke | Internal Medicine | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2005-05-24 |
| 1144858713 | Dawn P Mccullough | Nurse Practitioner | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2020-03-30 |
| 1881230266 | Kasey Jankowski | Physician Assistant | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2019-11-21 |
| 1699247486 | Erin Joanne Broda | Advanced Practice Midwife | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2018-12-18 |
| 1467928440 | Ashley Naas | Physical Therapist | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2018-10-17 |
| 1689167942 | Marissa Adrian | Physician Assistant | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2018-06-12 |
| 1427585736 | Nicole Will | Physical Medicine & Rehabilitation | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2017-05-17 |
| 1588111215 | Jennifer Gibbons | Registered Nurse | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2016-09-11 |
| 1639520414 | Lauren Isabel Useem | Obstetrics & Gynecology | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2016-06-23 |
| 1437506110 | Jessica Zarzecki | Physician Assistant | 1821 S Webster Ave, Green Bay, WI 54301-2253 | 2016-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386102465 | Parc Village Dental, LLC | Dentist | 2805 Libal Street, Suite A, Green Bay, WI 54301 | 2019-03-07 |
| 1598229478 | Shaina Marie Conner | Registered Nurse | 835 S Vanburen St, Green Bay, WI 54301 | 2019-01-25 |
| 1093298960 | Brown County | Case Management | 111 N. Jefferson Street, Green Bay, WI 54301 | 2018-09-07 |
| 1639609928 | Frontline Healthcare LLC | Specialist/Technologist, Other | 2221 S. Webster Ave. Suite 270, Greenbay, WI 54301 | 2017-06-19 |
| 1992242606 | Charmaine Rimple | Counselor | 526 South Monroe Avenue, Green Bay, WI 54301 | 2017-01-20 |
| 1962944819 | Rebecca Lucille Reinbold | Registered Nurse | 917 Catherine Street, Green Bay, WI 54301 | 2016-11-09 |
| 1730635061 | Melissa Kristof | Specialist/Technologist, Other | 1821 Sounth Webster Ave., Green Bay, WI 54301 | 2016-08-28 |
| 1255709747 | Vivian Sweetheart Bishop-cook | Counselor | 2920 South Webster Ave, Green Bay, WI 54301 | 2015-09-14 |
| 1881079960 | Chelsi S Weber | Registered Nurse | 2300 Riverside Dr., Ste 204, Green Bay, WI 54301 | 2015-07-30 |
| 1962816371 | Joelle M Hesse | Counselor | 630 Cherry St., Green Bay, WI 54301 | 2014-06-13 |
| Find all providers in zip 54301 | ||||
| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376963694 | Shannon C Pollock | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2014-04-25 |
| 1972947224 | Samuel J Adams | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226 | 2013-04-17 |
| 1699036129 | Alexandria Lynn Lutley | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2012-05-31 |
| 1063779601 | Kumar R Sannagowdara | Psychiatry & Neurology | 12500 Aurora Dr, Pleasant Prairie, WI 53158-1227 | 2012-04-20 |
| 1942597356 | Lileth Joy Mondok | Psychiatry & Neurology | 9000 W Wisconsin Avenue, Pediatric Neurology, Milwaukee, WI 53226-4874 | 2011-07-06 |
| 1144532052 | Raquel Farias-moeller | Psychiatry & Neurology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2010-07-08 |
| 1801002092 | Delphin Sallowm | Psychiatry & Neurology | 9000 W Wisconsin Ave, Pediatric Neurology, Milwaukee, WI 53226-4874 | 2007-05-15 |
| 1659443620 | Dorota Halina Telega | Psychiatry & Neurology | N84w16889 Menomonee Ave, Menomonee Falls, WI 53051-2810 | 2006-11-14 |
| 1063592301 | Sergio Facchini | Psychiatry & Neurology | 600 Highland Ave, Madison, WI 53792-0001 | 2006-10-17 |
| 1003912346 | Richard V Colan | Psychiatry & Neurology | 8825 S Howell Ave, Suite 101, Oak Creek, WI 53154-3760 | 2006-09-15 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on TERENCE SHAUN EDGAR.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.