Provider Demographics
NPI:1962907295
Name:GARNER, JILL M (RN, CDE)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:GARNER
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LILAC LN
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-1839
Mailing Address - Country:US
Mailing Address - Phone:603-969-9823
Mailing Address - Fax:
Practice Address - Street 1:11 CRUM ELBOW RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2852
Practice Address - Country:US
Practice Address - Phone:845-229-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY742503-1163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator