Provider Demographics
NPI:1770193666
Name:GRABOSKY, JILL (RN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GRABOSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 KENNA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-2656
Mailing Address - Country:US
Mailing Address - Phone:304-610-1808
Mailing Address - Fax:
Practice Address - Street 1:4329 HUGHES BRANCH RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-9768
Practice Address - Country:US
Practice Address - Phone:304-733-6415
Practice Address - Fax:304-733-6429
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV73634163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management