Provider Demographics
NPI:1093112880
Name:HAMBLY, JILL S (LPN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:S
Last Name:HAMBLY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 KEVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1367
Mailing Address - Country:US
Mailing Address - Phone:541-232-4423
Mailing Address - Fax:
Practice Address - Street 1:1800 MILLRACE DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1992
Practice Address - Country:US
Practice Address - Phone:541-434-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-23
Last Update Date:2014-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079011536LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse