Provider Demographics
NPI:1083139349
Name:CISZEWSKI, JILL MARIE (AGACNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:CISZEWSKI
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:ELSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP
Mailing Address - Street 1:27278 RONEY AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4849
Mailing Address - Country:US
Mailing Address - Phone:734-552-6526
Mailing Address - Fax:
Practice Address - Street 1:27278 RONEY AVE
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-4849
Practice Address - Country:US
Practice Address - Phone:734-552-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704170540363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704170540Medicaid