Healthcare Provider Details

I. General information

NPI: 1760796858
Provider Name (Legal Business Name): ERIN HILLARY TERPSTRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 WONDERLY AVE
DAYTON OH
45419-1758
US

IV. Provider business mailing address

331 WONDERLY AVE
DAYTON OH
45419-1758
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-9997
  • Fax: 937-293-5922
Mailing address:
  • Phone: 937-293-9997
  • Fax: 937-293-5922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN309659
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN309659
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN309659
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN309659
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: