Provider Demographics
NPI:1124638507
Name:SALAMON, JILL D (ARNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:SALAMON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 NAGOG HILL RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3234
Mailing Address - Country:US
Mailing Address - Phone:781-956-9467
Mailing Address - Fax:
Practice Address - Street 1:312 NAGOG HILL RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3234
Practice Address - Country:US
Practice Address - Phone:781-956-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN207312363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily