Healthcare Provider Details

I. General information

NPI: 1457105181
Provider Name (Legal Business Name): JILLIANE PUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1167 MUNROE FALLS KENT RD
KENT OH
44240-3315
US

IV. Provider business mailing address

1167 MUNROE FALLS KENT RD
KENT OH
44240-3315
US

V. Phone/Fax

Practice location:
  • Phone: 330-577-7110
  • Fax:
Mailing address:
  • Phone: 330-577-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: