Provider Demographics
NPI:1356162705
Name:RAUCHUT, JILLIAN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:RAUCHUT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 N BATON ROUGE AVE
Mailing Address - Street 2:
Mailing Address - City:VENTNOR CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08406-2407
Mailing Address - Country:US
Mailing Address - Phone:267-255-9938
Mailing Address - Fax:
Practice Address - Street 1:1076 ROUTE 47 S
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08242-1608
Practice Address - Country:US
Practice Address - Phone:609-741-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15172600363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health