Provider Demographics
NPI:1417392275
Name:RHOADES, JILL MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:RHOADES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27177 STATE HIGHWAY 189 STE F
Mailing Address - Street 2:
Mailing Address - City:BLUE JAY
Mailing Address - State:CA
Mailing Address - Zip Code:92317-0017
Mailing Address - Country:US
Mailing Address - Phone:195-180-5942
Mailing Address - Fax:
Practice Address - Street 1:27177 STATE HIGHWAY 189 STE F
Practice Address - Street 2:
Practice Address - City:BLUE JAY
Practice Address - State:CA
Practice Address - Zip Code:92317-0017
Practice Address - Country:US
Practice Address - Phone:951-805-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN215279164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse