Provider Demographics
NPI:1114021268
Name:BACKER, JILL HOPE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:HOPE
Last Name:BACKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:HOPE
Other - Last Name:MECKLOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1801 VICENTE STREET
Mailing Address - Street 2:THE EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2923
Mailing Address - Country:US
Mailing Address - Phone:415-681-3211
Mailing Address - Fax:415-664-7094
Practice Address - Street 1:1801 VICENTE STREET
Practice Address - Street 2:THE EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2923
Practice Address - Country:US
Practice Address - Phone:415-681-3211
Practice Address - Fax:415-664-7094
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN346488163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse