Provider Demographics
NPI:1104105865
Name:TERRIEN, JILL M (NP)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:TERRIEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 CHANDLER ST
Mailing Address - Street 2:ROOM G-209
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2861
Mailing Address - Country:US
Mailing Address - Phone:508-929-8875
Mailing Address - Fax:
Practice Address - Street 1:486 CHANDLER ST
Practice Address - Street 2:ROOM G-209
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2861
Practice Address - Country:US
Practice Address - Phone:508-929-8875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159440363LA2200X
CT003055363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health