Provider Demographics
NPI:1235880626
Name:FRIEND, JILLIAN MICHELLE
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MICHELLE
Last Name:FRIEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-2615
Mailing Address - Country:US
Mailing Address - Phone:240-527-5127
Mailing Address - Fax:
Practice Address - Street 1:220 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-2615
Practice Address - Country:US
Practice Address - Phone:240-527-5127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care