Provider Demographics
NPI:1457105181
Name:PUGH, JILLIANE
Entity Type:Individual
Prefix:
First Name:JILLIANE
Middle Name:
Last Name:PUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 MUNROE FALLS KENT RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3315
Mailing Address - Country:US
Mailing Address - Phone:330-577-7110
Mailing Address - Fax:
Practice Address - Street 1:1167 MUNROE FALLS KENT RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3315
Practice Address - Country:US
Practice Address - Phone:330-577-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No171400000XOther Service ProvidersHealth & Wellness Coach