Provider Demographics
NPI:1023310877
Name:PISKADLO, JENNIFER (MSN, CRNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PISKADLO
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 MANOR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2063
Mailing Address - Country:US
Mailing Address - Phone:201-290-3765
Mailing Address - Fax:
Practice Address - Street 1:36 MADISON AVE
Practice Address - Street 2:DREW UNIVERSITY STUDENT HEALTH SERVICES
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-1434
Practice Address - Country:US
Practice Address - Phone:973-408-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010921363LF0000X
NJ26NJ00398400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily