Individual
MRS. JILL MARIE WEGENER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
292 MAIN ST, STATEN ISLAND, NY 10307-1724
(718) 966-8543
Mailing address
292 MAIN ST, STATEN ISLAND, NY 10307-1724
(718) 966-8543
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
390175-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02247950
—
NY
Enumeration date
07/16/2007
Last updated
07/16/2007
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