Provider Demographics
NPI:1831429869
Name:SMOTRYSKI, JILL M (PA-C)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:SMOTRYSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1623 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2031
Mailing Address - Country:US
Mailing Address - Phone:570-241-4715
Mailing Address - Fax:570-261-2015
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1624
Practice Address - Country:US
Practice Address - Phone:570-770-3415
Practice Address - Fax:570-770-3420
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002443363A00000X
PAMA054279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicare PIN