MARY JILL VAILLANCOURT CRNP NPI 1104290915

NPI Information

  • NPI: 1104290915
  • Provider Name: MARY JILL VAILLANCOURT, CRNP
  • Classification: Nurse Practitioner - 363LA2200X
  • Specialization: Adult Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 107 INSTITUTE ST
    JAMESTOWN, NY
    ZIP 14701
  • Phone: (716) 484-4334

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NPI Details

Mary Jill Vaillancourt, CRNP is an adult health nurse practitioner in Jamestown, NY. Mary Jill Vaillancourt, CRNP NPI is 1104290915. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

107 INSTITUTE ST
JAMESTOWN, NY
ZIP 14701-628
Phone: (716) 484-4334
Fax: (833) 974-2029

The NPI 1104290915 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Follow-up nursing facility visit per day, typically 25 minutes (HCPCS:99309)
  • Extended inpatient or observation hospital service, first hour (HCPCS:99356)

The enumeration date for this NPI number is 11/17/2015 and was last updated on 8/31/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363L00000XNurse PractitionerSP015710PENNSYLVANIANo
2363LA2200XNurse PractitionerAdult HealthF307302NEW YORKYes
3363LA2200XNurse PractitionerAdult HealthSP015710PENNSYLVANIANo
4363LG0600XNurse PractitionerGerontologySP015710PENNSYLVANIANo
5163W00000XRegistered NurseRN578441PENNSYLVANIANo
6163W00000XRegistered Nurse362456NEW YORKNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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