Provider Demographics
NPI:1255655510
Name:FEDERER, JILL LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LYNN
Last Name:FEDERER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:IHA BREAST SURGERY
Practice Address - Street 2:5320 ELLIOTT DRIVE SUITE 203
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-1700
Practice Address - Fax:734-887-8938
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2023-08-09
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Provider Licenses
StateLicense IDTaxonomies
MI4704230297163WR0006X, 363LF0000X
OH3007458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJF230297OtherRN LIC.