Provider Demographics
NPI:1295202596
Name:DOHRN, JILLIAN P (PNP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:P
Last Name:DOHRN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 W UNION HILLS DR STE D100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1361
Mailing Address - Country:US
Mailing Address - Phone:602-978-2500
Mailing Address - Fax:602-938-2198
Practice Address - Street 1:5940 W UNION HILLS DR STE D100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1361
Practice Address - Country:US
Practice Address - Phone:602-978-2500
Practice Address - Fax:602-938-2198
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ218671363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty