Provider Demographics
NPI:1831858935
Name:MARCALUS, JILLIAN ANN (BSN)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ANN
Last Name:MARCALUS
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PROSPECT STREET
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2871
Mailing Address - Country:US
Mailing Address - Phone:610-376-6077
Mailing Address - Fax:610-376-6944
Practice Address - Street 1:1402 LAUREL BLVD STE B
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1427
Practice Address - Country:US
Practice Address - Phone:610-376-6077
Practice Address - Fax:610-376-6944
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN678160163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health