Provider Demographics
NPI:1437694353
Name:ROPER, JILL
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:
Last Name:ROPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-9726
Mailing Address - Country:US
Mailing Address - Phone:517-899-8869
Mailing Address - Fax:
Practice Address - Street 1:2100 NICHOLS RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-9726
Practice Address - Country:US
Practice Address - Phone:517-899-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-01
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000020176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife