Provider Demographics
NPI:1932653854
Name:MUDRY, JILLIAN LAURA
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:LAURA
Last Name:MUDRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:LAURA
Other - Last Name:ZUPPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28539 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-4798
Mailing Address - Country:US
Mailing Address - Phone:302-648-2099
Mailing Address - Fax:
Practice Address - Street 1:28539 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4798
Practice Address - Country:US
Practice Address - Phone:302-648-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0048829163W00000X
DELG-0011687363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse