Provider Demographics
NPI:1316973548
Name:BALLENGER, JILL C (ANP-BC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:BALLENGER
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 GRISCOM DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-2005
Mailing Address - Country:US
Mailing Address - Phone:609-381-5698
Mailing Address - Fax:
Practice Address - Street 1:700 FOULK RD
Practice Address - Street 2:VISTA MEDICAL SERVICES, MANOR CARE NURSING HOME
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3708
Practice Address - Country:US
Practice Address - Phone:609-381-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00107900363LA2200X
DELB-0000193363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ117282DUTMedicare PIN
DE020961Medicare PIN
NJ117282Medicare PIN
DE020961V39Medicare PIN