Provider Demographics
NPI:1790851798
Name:QUILL, JAN CAROL (CRNFA)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:CAROL
Last Name:QUILL
Suffix:
Gender:F
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 SALOMON LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1104
Mailing Address - Country:US
Mailing Address - Phone:610-296-8345
Mailing Address - Fax:610-296-8723
Practice Address - Street 1:1463 SALOMON LN
Practice Address - Street 2:
Practice Address - City:CHESTERBROOK
Practice Address - State:PA
Practice Address - Zip Code:19087-1104
Practice Address - Country:US
Practice Address - Phone:610-296-8345
Practice Address - Fax:610-296-8723
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN317553L163WR0006X
NJ26NR12132700163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant