Individual
JILL ROBIN SISKIND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
100 SOUTH ST, SOUTHBRIDGE, MA 01550-4051
(508) 765-9771
(508) 909-7735
Mailing address
100 SOUTH ST, SOUTHBRIDGE, MA 01550-4051
(508) 765-9771
(508) 909-7735
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
E37913
CT
363L00000X
Nurse Practitioner
001917
CT
363LA2100X
Acute Care Nurse Practitioner
Primary
RN134682
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004190188
—
CT
01
—
191700
CONNECTICAR
CT
01
—
400001917CT01
ANTHEM BCBS
CT
Enumeration date
09/22/2005
Last updated
12/21/2011
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