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General NPI Number Information
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NPI Number | 1649057688
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Entity Type | Individual
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Provider Name | JILLIAN ROSE MOFFETT
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Gender | Female
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 9300 VALLEY CHILDRENS PL
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City | MADERA
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State | CA
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Zip | 93636-8762
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Country | US
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Telephone | 559-353-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 620 VETERANS BLVD UNIT 516
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City | REDWOOD CITY
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State | CA
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Zip | 94063-1486
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Country | US
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Telephone |
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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 | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | 95031258
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95031258
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 153014
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 163WP0218X
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Taxonomy Name | Pediatric Oncology Registered Nurse
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License Number | 95328625
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 163WP0218X
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Taxonomy Name | Pediatric Oncology Registered Nurse
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License Number | 153014
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95328625
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License Number State | CA
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