Provider Demographics
NPI:1760658934
Name:DOUGLAS, TERRILL E (RN)
Entity Type:Individual
Prefix:MS
First Name:TERRILL
Middle Name:E
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:RN
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 108
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05362-0108
Mailing Address - Country:US
Mailing Address - Phone:802-348-9361
Mailing Address - Fax:
Practice Address - Street 1:44 DOVER ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:VT
Practice Address - Zip Code:05362
Practice Address - Country:US
Practice Address - Phone:802-348-9361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026-0012950163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health