Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | SP014105 | PA |
NPI | 1043600380 |
---|---|
Provider Name | Miss Jillian Frances Queeney |
First Address | Philadelphia, PA 19120-2470 |
Second Address | Philadelphia, PA 19114-2860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2015 |
Last Update Date | 11/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1030043470003 | (05) | PA |