Provider Demographics
NPI:1346012663
Name:CROSGROVE, JILLIAN (RN)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:CROSGROVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 NW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:MALCOLM
Mailing Address - State:NE
Mailing Address - Zip Code:68402-9561
Mailing Address - Country:US
Mailing Address - Phone:402-796-2151
Mailing Address - Fax:
Practice Address - Street 1:10004 NW 112TH ST
Practice Address - Street 2:
Practice Address - City:MALCOLM
Practice Address - State:NE
Practice Address - Zip Code:68402-9561
Practice Address - Country:US
Practice Address - Phone:402-796-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE79000163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool