Provider Demographics
NPI:1902100324
Name:DECOLOGERO, JILL ELIZABETH (ANP-BC, MSN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ELIZABETH
Last Name:DECOLOGERO
Suffix:
Gender:F
Credentials:ANP-BC, MSN
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Mailing Address - Street 1:3 WOODLAND RD STE 322
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1713
Mailing Address - Country:US
Mailing Address - Phone:781-662-2243
Mailing Address - Fax:781-662-4878
Practice Address - Street 1:3 WOODLAND RD STE 322
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1713
Practice Address - Country:US
Practice Address - Phone:781-662-2243
Practice Address - Fax:781-662-4878
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN267529363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health