Provider Demographics
NPI:1689287849
Name:LELL, TERRIE NICHOLE
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:NICHOLE
Last Name:LELL
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:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:EDGARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25672-0026
Mailing Address - Country:US
Mailing Address - Phone:276-701-1295
Mailing Address - Fax:
Practice Address - Street 1:1895 RT. 49
Practice Address - Street 2:
Practice Address - City:EDGARTON
Practice Address - State:WV
Practice Address - Zip Code:25672
Practice Address - Country:US
Practice Address - Phone:276-701-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant