Provider Demographics
NPI:1639517956
Name:HILL-FREDERICK, JEANETTE CALANDRA (HAIRLOSS SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:CALANDRA
Last Name:HILL-FREDERICK
Suffix:
Gender:F
Credentials:HAIRLOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 OLD TROLLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5682
Mailing Address - Country:US
Mailing Address - Phone:843-532-6976
Mailing Address - Fax:
Practice Address - Street 1:418 OLD TROLLEY RD STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5682
Practice Address - Country:US
Practice Address - Phone:843-532-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15701744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management