Provider Demographics
NPI:1518419894
Name:HALL-CRUM, JILL LYNN
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LYNN
Last Name:HALL-CRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:LYNN
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-321-5257
Mailing Address - Fax:760-773-1631
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-321-5257
Practice Address - Fax:760-773-1631
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily