Jillian Divergilio
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Waterbury, CT
NPI 1346984150 · NPPES record last updated Apr 27, 2022
Key facts
- NPI
- 1346984150
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 79 Beacon St
Waterbury, CT 06704-3424 - Phone
- (203) 574-9000
- NPI assigned
- Apr 27, 2022
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
79 Beacon St
Waterbury, CT 06704-3424
Mailing address
141 E Main St
Waterbury, CT 06702-2310
Other providers in Waterbury, CT
- Shira Diskind
- Laura Ditillo
- Maria Ditomasso
- Jennifer Kate Ditunno
- Debra M Divenere
- Essence Divine
- Catarina Divito
- Kelsey Dlugozima
- Jason V DO
- Joan M Doback
All providers in Waterbury, CT · Student in an Organized Health Care Education/Training Program in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.