Individual
MARY JILL VAILLANCOURT
Active
Individual
MARY JILL VAILLANCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
362456
NY
163W00000X
Registered Nurse
RN578441
PA
363L00000X
Nurse Practitioner
SP015710
PA
363LA2200X
Adult Health Nurse Practitioner
Primary
F307302
NY
363LA2200X
Adult Health Nurse Practitioner
SP015710
PA
363LG0600X
Gerontology Nurse Practitioner
SP015710
PA
Other
Enumeration date
11/17/2015
Last updated
08/31/2023
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