Provider Demographics
NPI:1679139638
Name:STILLMAN, JENNIFER R
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:STILLMAN
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 1:732 CLINTON BY PASS RD
Mailing Address - Street 2:
Mailing Address - City:NORMALVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15469-1224
Mailing Address - Country:US
Mailing Address - Phone:724-322-4884
Mailing Address - Fax:
Practice Address - Street 1:732 CLINTON BY PASS RD
Practice Address - Street 2:
Practice Address - City:NORMALVILLE
Practice Address - State:PA
Practice Address - Zip Code:15469-1224
Practice Address - Country:US
Practice Address - Phone:724-322-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker