Provider Demographics
NPI:1306590948
Name:KILOLONG, JANE PARANAE
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:PARANAE
Last Name:KILOLONG
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 1:1732 HAVENBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9677
Mailing Address - Country:US
Mailing Address - Phone:704-640-5373
Mailing Address - Fax:
Practice Address - Street 1:3637 OLD VINEYARD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4842
Practice Address - Country:US
Practice Address - Phone:336-794-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC243354163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health