Provider Demographics
NPI:1417186065
Name:ADOLPH, TREVA R
Entity Type:Individual
Prefix:
First Name:TREVA
Middle Name:R
Last Name:ADOLPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 S PLEASANT GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9188
Mailing Address - Country:US
Mailing Address - Phone:740-252-8991
Mailing Address - Fax:
Practice Address - Street 1:465 S PLEASANT GROVE CIR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-9188
Practice Address - Country:US
Practice Address - Phone:740-252-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-03
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide