Provider Demographics
NPI:1144529850
Name:PETERSON, JILL ANNE (RN, MSN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ANNE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2613
Mailing Address - Country:US
Mailing Address - Phone:617-784-8556
Mailing Address - Fax:
Practice Address - Street 1:29 BROAD ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2613
Practice Address - Country:US
Practice Address - Phone:617-784-8556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6119363LP0200X
CT6119363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics