Provider Demographics
NPI:1235447715
Name:KORDAS, JILL ELISE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JILL
Middle Name:ELISE
Last Name:KORDAS
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:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-0082
Mailing Address - Country:US
Mailing Address - Phone:413-237-9859
Mailing Address - Fax:
Practice Address - Street 1:50 PINEYWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9359
Practice Address - Country:US
Practice Address - Phone:413-237-9859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-19
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2316572363LF0000X
MA62698164W00000X
CT034528164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse