Provider Demographics
NPI:1174880678
Name:PARENT, JILL ANN (RN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:PARENT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 SAND RD
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-2930
Mailing Address - Country:US
Mailing Address - Phone:518-572-5705
Mailing Address - Fax:
Practice Address - Street 1:233 SAND RD
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-2930
Practice Address - Country:US
Practice Address - Phone:518-572-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY478059-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse