Provider Demographics
NPI:1093984502
Name:DAY, JILL ELLEN (CRNA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ELLEN
Last Name:DAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:FRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2432 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8069
Mailing Address - Country:US
Mailing Address - Phone:810-606-6499
Mailing Address - Fax:810-606-7245
Practice Address - Street 1:1 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8065
Practice Address - Country:US
Practice Address - Phone:810-606-6499
Practice Address - Fax:810-606-7245
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704215188367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered