Provider Demographics
NPI:1881282663
Name:MOSSBROOKS, JILL ANNE (AAS)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ANNE
Last Name:MOSSBROOKS
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MEADOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-4517
Mailing Address - Country:US
Mailing Address - Phone:609-364-6218
Mailing Address - Fax:
Practice Address - Street 1:13 MEADOW WOOD DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-4517
Practice Address - Country:US
Practice Address - Phone:609-364-6218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator