Provider Demographics
NPI:1437913670
Name:STILLITANO, KERA (APN)
Entity Type:Individual
Prefix:
First Name:KERA
Middle Name:
Last Name:STILLITANO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-1548
Mailing Address - Country:US
Mailing Address - Phone:609-556-8836
Mailing Address - Fax:
Practice Address - Street 1:81 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08620-1548
Practice Address - Country:US
Practice Address - Phone:609-556-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15007600363L00000X
NJ26NR13053200163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse