Provider Demographics
NPI:1942816988
Name:TERRILLION, AMANDA MAE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAE
Last Name:TERRILLION
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 1:25059 WOOLWORTH ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-9592
Mailing Address - Country:US
Mailing Address - Phone:315-493-5000
Mailing Address - Fax:
Practice Address - Street 1:25059 WOOLWORTH ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9592
Practice Address - Country:US
Practice Address - Phone:315-493-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY696431163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty