Provider Demographics
NPI:1598996829
Name:SANDUTCH, JILL CROMPTON (CRNP-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CROMPTON
Last Name:SANDUTCH
Suffix:
Gender:F
Credentials:CRNP-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:LARAINE
Other - Last Name:CROMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:445 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3601
Mailing Address - Country:US
Mailing Address - Phone:570-718-0520
Mailing Address - Fax:
Practice Address - Street 1:445 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3601
Practice Address - Country:US
Practice Address - Phone:570-718-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily