Provider Demographics
NPI:1225111677
Name:ILLS, JANICE JEAN (RN,CROR,CRNFA)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:JEAN
Last Name:ILLS
Suffix:
Gender:F
Credentials:RN,CROR,CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8004 TAHOE PARKE CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4051
Mailing Address - Country:US
Mailing Address - Phone:512-336-8668
Mailing Address - Fax:512-336-8668
Practice Address - Street 1:8004 TAHOE PARKE CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4051
Practice Address - Country:US
Practice Address - Phone:512-336-8668
Practice Address - Fax:512-336-8668
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX415738282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital