Provider Demographics
NPI:1912474198
Name:TERWILLIGER, PAMELA J (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:TERWILLIGER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 COUNTY ROUTE 64
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-9730
Mailing Address - Country:US
Mailing Address - Phone:585-746-0658
Mailing Address - Fax:
Practice Address - Street 1:5920 COUNTY ROUTE 64
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-9730
Practice Address - Country:US
Practice Address - Phone:585-746-0658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY507442163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse