Provider Demographics
NPI:1184379364
Name:BADILLO, JENNIFER (CLD)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:BADILLO
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W STEPHEN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-1867
Mailing Address - Country:US
Mailing Address - Phone:910-545-5328
Mailing Address - Fax:
Practice Address - Street 1:10 W STEPHEN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-1867
Practice Address - Country:US
Practice Address - Phone:910-545-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPR8-202115374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty