Healthcare Provider Details

I. General information

NPI: 1760658934
Provider Name (Legal Business Name): TERRILL E DOUGLAS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DOVER ROAD
WILLIAMSVILLE VT
05362
US

IV. Provider business mailing address

PO BOX 108
WILLIAMSVILLE VT
05362-0108
US

V. Phone/Fax

Practice location:
  • Phone: 802-348-9361
  • Fax:
Mailing address:
  • Phone: 802-348-9361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number026-0012950
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: