Provider Demographics
NPI:1760998298
Name:HILL, DONNA SUE (PCA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:SUE
Last Name:HILL
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:SUE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:175 TRUSSLE ROAD
Mailing Address - Street 2:
Mailing Address - City:SOD
Mailing Address - State:WV
Mailing Address - Zip Code:25564
Mailing Address - Country:US
Mailing Address - Phone:304-356-4562
Mailing Address - Fax:304-558-4563
Practice Address - Street 1:175 TUSSLE ROAD
Practice Address - Street 2:
Practice Address - City:SOD
Practice Address - State:WV
Practice Address - Zip Code:25564
Practice Address - Country:US
Practice Address - Phone:304-756-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant