Provider Demographics
NPI:1164672010
Name:CLAYBAUGH, TERRA RENEE (RN)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:RENEE
Last Name:CLAYBAUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 TURNBULL RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2325
Mailing Address - Country:US
Mailing Address - Phone:937-429-4805
Mailing Address - Fax:
Practice Address - Street 1:1911 TURNBULL RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2325
Practice Address - Country:US
Practice Address - Phone:937-429-4805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN312624163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health