Provider Demographics
NPI:1417441502
Name:DUCLOS, JILL (RN MSN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:DUCLOS
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:DUCLOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN MSN
Mailing Address - Street 1:500 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-5215
Mailing Address - Country:US
Mailing Address - Phone:814-943-0414
Mailing Address - Fax:
Practice Address - Street 1:500 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-5215
Practice Address - Country:US
Practice Address - Phone:814-943-0414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN527484L163WP0808X
PASP023790363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health