Provider Demographics
NPI:1417666116
Name:HILL, TRINA JOSEPHINA
Entity Type:Individual
Prefix:MRS
First Name:TRINA
Middle Name:JOSEPHINA
Last Name:HILL
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 1:27 KEENELAND TRL
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7111
Mailing Address - Country:US
Mailing Address - Phone:803-404-0229
Mailing Address - Fax:803-736-9721
Practice Address - Street 1:27 KEENELAND TRL
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7111
Practice Address - Country:US
Practice Address - Phone:803-404-0229
Practice Address - Fax:803-736-9721
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2628133V00000X
SC2528133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2528OtherRDN LICENSE