Provider Demographics
NPI:1336462449
Name:LAROCK, JILL ADLA (RN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ADLA
Last Name:LAROCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 COUNTY ROUTE 40
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-3138
Mailing Address - Country:US
Mailing Address - Phone:315-575-1962
Mailing Address - Fax:
Practice Address - Street 1:70 COUNTY ROUTE 40
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-3138
Practice Address - Country:US
Practice Address - Phone:315-575-1962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY583870163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse