Provider Demographics
NPI:1750615860
Name:EMERSON, JILLIAN MARIE (LPN)
Entity type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:MARIE
Last Name:EMERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ELM ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2829
Mailing Address - Country:US
Mailing Address - Phone:315-283-0235
Mailing Address - Fax:
Practice Address - Street 1:15 ELM ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2829
Practice Address - Country:US
Practice Address - Phone:315-283-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298349164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse