Provider Demographics
NPI:1801109905
Name:AMILL, JADIRA (RN- APN)
Entity type:Individual
Prefix:MRS
First Name:JADIRA
Middle Name:
Last Name:AMILL
Suffix:
Gender:F
Credentials:RN- APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3024
Mailing Address - Country:US
Mailing Address - Phone:908-822-9099
Mailing Address - Fax:908-822-0449
Practice Address - Street 1:1010 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3024
Practice Address - Country:US
Practice Address - Phone:908-822-9099
Practice Address - Fax:908-822-0449
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00297000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health