Provider Demographics
NPI:1467673483
Name:KILROY, JEANNE M (MSN, NP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:KILROY
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:M
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:275 PATTERSON AVENUE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424
Mailing Address - Country:US
Mailing Address - Phone:973-785-3334
Mailing Address - Fax:973-785-7760
Practice Address - Street 1:275 PATTERSON AVENUE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424
Practice Address - Country:US
Practice Address - Phone:973-785-3334
Practice Address - Fax:973-785-7760
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03690100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0225410Medicaid
NJ012189XDCMedicare PIN
NJ0225410Medicaid