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General NPI Number Information
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NPI Number | 1013448307
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Entity Type | Individual
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Provider Name | JILLIAN ULLO
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Gender | Female
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 65 W JIMMIE LEEDS RD
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City | POMONA
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State | NJ
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Zip | 08240-9102
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Country | US
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Telephone | 609-748-7089
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Fax |
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Provider Business Mailing Address
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Address Line | 5 FOX TAIL CT
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City | SEWELL
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State | NJ
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Zip | 08080-3064
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Country | US
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Telephone | 856-381-6124
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00708800
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License Number State | NJ
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