Provider Demographics
NPI:1710697065
Name:HILLLACY, TEREVA JEANNE
Entity Type:Individual
Prefix:
First Name:TEREVA
Middle Name:JEANNE
Last Name:HILLLACY
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 1:217 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:SPENCERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45887-1246
Mailing Address - Country:US
Mailing Address - Phone:419-203-3038
Mailing Address - Fax:
Practice Address - Street 1:217 N PEARL ST
Practice Address - Street 2:
Practice Address - City:SPENCERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45887-1246
Practice Address - Country:US
Practice Address - Phone:419-203-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider