Provider Demographics
NPI:1477064665
Name:ZDAN, JILL MARIE (NMD, PA-C)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:ZDAN
Suffix:
Gender:F
Credentials:NMD, PA-C
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18012 W LAWRENCE LN
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-7515
Mailing Address - Country:US
Mailing Address - Phone:928-460-3305
Mailing Address - Fax:
Practice Address - Street 1:9250 N 3RD ST STE 3025
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2428
Practice Address - Country:US
Practice Address - Phone:602-944-4628
Practice Address - Fax:602-944-2805
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1652175F00000X
AZ9838363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No175F00000XOther Service ProvidersNaturopath