Provider Demographics
NPI:1114288602
Name:NEMETH, JILLIAN NICOLE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:NICOLE
Last Name:NEMETH
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DARE LN
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-6601
Mailing Address - Country:US
Mailing Address - Phone:215-528-8759
Mailing Address - Fax:
Practice Address - Street 1:116 E KING ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-2516
Practice Address - Country:US
Practice Address - Phone:610-644-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11129635174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN