MEDICARE: MS. JILL MARIE PEARCE M.S., C.A.S., LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	319644	NY

General Provider Information

NPI Number	:	1821487018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL MARIE PEARCE M.S., C.A.S., LPN

Provider Business Mailing Address
First Line	:	36 FOREST MEADOW TRAIL
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1154
Country	:	US
Telephone Number	:	585-739-5890
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 FOREST MEADOW TRL
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1154
Country	:	US
Telephone Number	:	585-739-5890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	01/12/2015

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