Healthcare Provider Details

I. General information

NPI: 1952642753
Provider Name (Legal Business Name): JILL RENEE PATRONAGIO D.V.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SILVER LAKE RD
HOLLIS NH
03049-6251
US

IV. Provider business mailing address

11 SILVER LAKE RD
HOLLIS NH
03049-6251
US

V. Phone/Fax

Practice location:
  • Phone: 603-465-7071
  • Fax: 603-465-7091
Mailing address:
  • Phone: 603-465-7071
  • Fax: 603-465-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number1573
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: