Provider Demographics
NPI:1538109921
Name:OSWALT, JILL (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:OSWALT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 ERRECART BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-8334
Mailing Address - Country:US
Mailing Address - Phone:775-777-0935
Mailing Address - Fax:775-777-0937
Practice Address - Street 1:2001 ERRECART BLVD
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8333
Practice Address - Country:US
Practice Address - Phone:775-777-0935
Practice Address - Fax:775-777-0937
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6077207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ642480Medicaid
AZ642480Medicaid
NVVWCHNV01Medicare PIN