Provider Demographics
NPI:1235693557
Name:NIELSEN-FARRELL, JILL MICHELLE
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MICHELLE
Last Name:NIELSEN-FARRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1616
Mailing Address - Country:US
Mailing Address - Phone:812-219-2339
Mailing Address - Fax:
Practice Address - Street 1:130 HYATTS RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8961
Practice Address - Country:US
Practice Address - Phone:740-214-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000267171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist