Provider Demographics
NPI:1114232444
Name:VREELAND, JILL MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:VREELAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 MAHANEY RD
Mailing Address - Street 2:P.O. BOX 352
Mailing Address - City:KING FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:13081-0352
Mailing Address - Country:US
Mailing Address - Phone:315-406-7850
Mailing Address - Fax:
Practice Address - Street 1:383 MAHANEY RD
Practice Address - Street 2:
Practice Address - City:KING FERRY
Practice Address - State:NY
Practice Address - Zip Code:13081-0352
Practice Address - Country:US
Practice Address - Phone:315-406-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294562-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse