Provider Demographics
NPI:1992736219
Name:BOSSERT-SQUERI, JILL MARION (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARION
Last Name:BOSSERT-SQUERI
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 BERKSHIRE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07438-9847
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:401-216-3854
Practice Address - Street 1:5740 BERKSHIRE VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-9847
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-216-3854
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333721-1363LF0000X
NJ26NJ00076700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123611XVAMedicare PIN
NJ123611XVAMedicare UPIN