Provider Demographics
NPI:1952705253
Name:DEFELICE, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:DEFELICE
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 1:405 LIBERTY STREET
Mailing Address - Street 2:PO BOX 646
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473-0646
Mailing Address - Country:US
Mailing Address - Phone:724-736-0443
Mailing Address - Fax:724-736-0454
Practice Address - Street 1:405 LIBERTY ST
Practice Address - Street 2:PO BOX 646
Practice Address - City:PERRYOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15473-0646
Practice Address - Country:US
Practice Address - Phone:724-736-0443
Practice Address - Fax:724-736-0454
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily