Healthcare Provider Details

I. General information

NPI: 1699685768
Provider Name (Legal Business Name): JILL GUPTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 WEST 12TH ST. 2560 WEST 12TH ST.
ERIE PA
16502
US

IV. Provider business mailing address

2560 WEST 12TH ST.
ERIE PA
16502
US

V. Phone/Fax

Practice location:
  • Phone: 814-456-2014
  • Fax:
Mailing address:
  • Phone: 814-456-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: