Provider Demographics
NPI:1710311345
Name:MCGILL, JESSICA V (CRNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:V
Last Name:MCGILL
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 1:4 MISSISSIPPI TRL
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-5800
Mailing Address - Country:US
Mailing Address - Phone:267-234-4121
Mailing Address - Fax:
Practice Address - Street 1:205 E LAUREL RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1301
Practice Address - Country:US
Practice Address - Phone:856-557-7539
Practice Address - Fax:856-875-9556
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013118363LF0000X
NJ26NJ01352200363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily