Provider Demographics
NPI:1407615586
Name:MCCORMICK, JILL (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:MCGREW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:1577 C ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5164
Mailing Address - Country:US
Mailing Address - Phone:907-205-6912
Mailing Address - Fax:
Practice Address - Street 1:1577 C ST STE 204
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5164
Practice Address - Country:US
Practice Address - Phone:907-205-6912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK205939163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health