Provider Demographics
NPI:1700580438
Name:DICKENSKI, JILLIAN (CRNP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:DICKENSKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:NICOLE
Other - Last Name:KOSENSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13926 OLD HANOVER RD
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-4206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2111 HANOVER PIKE
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-1319
Practice Address - Country:US
Practice Address - Phone:410-239-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR242141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily