Provider Demographics
NPI:1275131906
Name:PRICE, JILL S (IBCLC, RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:S
Last Name:PRICE
Suffix:
Gender:F
Credentials:IBCLC, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 STAGECOACH DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-8711
Mailing Address - Country:US
Mailing Address - Phone:720-276-2310
Mailing Address - Fax:
Practice Address - Street 1:781 STAGECOACH DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8711
Practice Address - Country:US
Practice Address - Phone:720-276-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0166520163WL0100X
COL-136024163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORN.0166520OtherDEPARTMENT OF REGULATIONS COLORADO