Provider Demographics
NPI:1043600380
Name:QUEENEY, JILLIAN FRANCES (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:FRANCES
Last Name:QUEENEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:FRANCES
Other - Last Name:CONDRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1338 BRISTOL PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5679
Mailing Address - Country:US
Mailing Address - Phone:215-632-5437
Mailing Address - Fax:215-824-4114
Practice Address - Street 1:1338 BRISTOL PIKE STE 202
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:PA
Practice Address - Zip Code:19020-5679
Practice Address - Country:US
Practice Address - Phone:215-632-5437
Practice Address - Fax:215-824-4114
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014105363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030043470003Medicaid