Provider Demographics
NPI:1083037808
Name:NORTHROP, JILL
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:NORTHROP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1042
Mailing Address - Country:US
Mailing Address - Phone:607-734-3901
Mailing Address - Fax:
Practice Address - Street 1:1879 DAVIS ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-1042
Practice Address - Country:US
Practice Address - Phone:607-734-3901
Practice Address - Fax:607-734-7224
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332444-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily