Individual
JILLIAN MARIE ROUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6 DIANA LN, WEST HAZLETON, PA 18202-1210
(570) 501-3760
(570) 501-3762
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA056492
PA
363A00000X
Physician Assistant
OA003152
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
326497F6K
MEDICARE PTAN
PA
Enumeration date
10/03/2013
Last updated
08/24/2020
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