Provider Demographics
NPI:1124857438
Name:REFICE, JILLIAN JUDE
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:JUDE
Last Name:REFICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434-1729
Mailing Address - Country:US
Mailing Address - Phone:570-877-3505
Mailing Address - Fax:
Practice Address - Street 1:915 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:PA
Practice Address - Zip Code:18434-1729
Practice Address - Country:US
Practice Address - Phone:570-877-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065420363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant