Provider Demographics
NPI:1356630883
Name:SMITH, JILL ANN (RN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3732 BARI WAY
Mailing Address - Street 2:B202
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-5590
Mailing Address - Country:US
Mailing Address - Phone:801-691-8731
Mailing Address - Fax:801-963-6945
Practice Address - Street 1:3732 BARI WAY
Practice Address - Street 2:B202
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5590
Practice Address - Country:US
Practice Address - Phone:801-691-8731
Practice Address - Fax:801-963-6945
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5411624-3102163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator