Provider Demographics
NPI:1427204536
Name:FRATEPIETRO, JILLIAN MARIE (RN, ANP-C)
Entity Type:Individual
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First Name:JILLIAN
Middle Name:MARIE
Last Name:FRATEPIETRO
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Gender:F
Credentials:RN, ANP-C
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Mailing Address - Street 1:HSC LEVEL T9 RM 040 UFPC SBUMC
Mailing Address - Street 2:STONY BROOK UROLOGY
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8093
Mailing Address - Country:US
Mailing Address - Phone:631-444-1916
Mailing Address - Fax:631-444-3765
Practice Address - Street 1:24 RESEARCH WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3487
Practice Address - Country:US
Practice Address - Phone:631-444-6270
Practice Address - Fax:631-444-6552
Is Sole Proprietor?:No
Enumeration Date:2008-08-09
Last Update Date:2012-11-27
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Provider Licenses
StateLicense IDTaxonomies
NY521994163W00000X
NY30305265363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY521994Medicaid