Provider Demographics
NPI:1588371322
Name:HENRY, JILL CHRISTINE
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTINE
Last Name:HENRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4745 OGLETOWN STANTON RD STE 217
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2074
Mailing Address - Country:US
Mailing Address - Phone:302-733-2410
Mailing Address - Fax:302-733-2602
Practice Address - Street 1:4745 OGLETOWN STANTON RD STE 217
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2074
Practice Address - Country:US
Practice Address - Phone:302-733-2410
Practice Address - Fax:302-733-2602
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0067963163W00000X
DELM-0010188363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163W00000XNursing Service ProvidersRegistered Nurse