Healthcare Provider Details

I. General information

NPI: 1023921459
Provider Name (Legal Business Name): JILLYAN STUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 CHAMBERSBURG RD
GETTYSBURG PA
17325-3310
US

IV. Provider business mailing address

1024 KESSLER DR
SHIPPENSBURG PA
17257-8972
US

V. Phone/Fax

Practice location:
  • Phone: 717-205-9652
  • Fax:
Mailing address:
  • Phone: 717-205-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: