Provider Demographics
NPI:1881330835
Name:PINO, JILLIAN RAE
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RAE
Last Name:PINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MANOWN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-8054
Mailing Address - Country:US
Mailing Address - Phone:304-594-6404
Mailing Address - Fax:
Practice Address - Street 1:26 MANOWN ST APT 1
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-8054
Practice Address - Country:US
Practice Address - Phone:304-594-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant