Provider Demographics
NPI:1417290271
Name:NEAL, JILL NICOLE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:NICOLE
Last Name:NEAL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:NICOLE
Other - Last Name:WHYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:5109 BROOKMEADOW CIR APT D
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-8292
Mailing Address - Country:US
Mailing Address - Phone:269-569-1238
Mailing Address - Fax:
Practice Address - Street 1:320 BRIGHAM ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1577
Practice Address - Country:US
Practice Address - Phone:269-685-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-30
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704230385163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology