Provider Demographics
NPI:1609667047
Name:WALLACE, JILL ZELANKO
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ZELANKO
Last Name:WALLACE
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 1:58 HALTERMAN RD LOT 11
Mailing Address - Street 2:
Mailing Address - City:NEW CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26743-8757
Mailing Address - Country:US
Mailing Address - Phone:814-699-0621
Mailing Address - Fax:
Practice Address - Street 1:58 HALTERMAN RD LOT 11
Practice Address - Street 2:
Practice Address - City:NEW CREEK
Practice Address - State:WV
Practice Address - Zip Code:26743-8757
Practice Address - Country:US
Practice Address - Phone:814-699-0621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant