Provider Demographics
NPI:1336372085
Name:KLUSOCZKY, JILL ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANN
Last Name:KLUSOCZKY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-3204
Mailing Address - Country:US
Mailing Address - Phone:607-760-7403
Mailing Address - Fax:
Practice Address - Street 1:46 BROOK AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-3204
Practice Address - Country:US
Practice Address - Phone:607-760-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182279-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse