Provider Demographics
NPI:1912191537
Name:GILLERN, JENNA (CPNP, MSN, RN)
Entity Type:Individual
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First Name:JENNA
Middle Name:
Last Name:GILLERN
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Gender:F
Credentials:CPNP, MSN, RN
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Other - First Name:
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:119 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1909
Practice Address - Country:US
Practice Address - Phone:856-547-7300
Practice Address - Fax:856-547-4573
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00131700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics