Provider Demographics
NPI:1558784124
Name:GILL, JENNIFER (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3443
Mailing Address - Country:US
Mailing Address - Phone:610-645-6555
Mailing Address - Fax:610-649-4744
Practice Address - Street 1:100 E LANCASTER AVE STE 330
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3443
Practice Address - Country:US
Practice Address - Phone:610-645-6555
Practice Address - Fax:610-649-4744
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-01
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016817363LA2200X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health