Provider Demographics
NPI:1497863831
Name:ADAMS, JILL LAVONNE (NP)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:LAVONNE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 SOUTH CALUMET RD.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304
Mailing Address - Country:US
Mailing Address - Phone:219-395-9500
Mailing Address - Fax:219-983-9511
Practice Address - Street 1:1100 SOUTH CALUMET RD.
Practice Address - Street 2:SUITE 2
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304
Practice Address - Country:US
Practice Address - Phone:219-395-9500
Practice Address - Fax:219-983-9511
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001844A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health