Provider Demographics
NPI:1073362182
Name:KILLEBREW, SONYA NATASHA
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:NATASHA
Last Name:KILLEBREW
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 1:1742 BERTINO WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-0079
Mailing Address - Country:US
Mailing Address - Phone:414-217-5718
Mailing Address - Fax:
Practice Address - Street 1:1742 BERTINO WAY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-0079
Practice Address - Country:US
Practice Address - Phone:414-217-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care