Provider Demographics
NPI:1760731426
Name:JARVIS, HILDA S (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:S
Last Name:JARVIS
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 DEBRA DR
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9323
Mailing Address - Country:US
Mailing Address - Phone:440-228-3977
Mailing Address - Fax:
Practice Address - Street 1:615 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3262
Practice Address - Country:US
Practice Address - Phone:440-228-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist