Provider Demographics
NPI:1568137099
Name:ANDERSON, JILL ALLISON
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ALLISON
Last Name:ANDERSON
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 1:1305 W 7TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4100
Mailing Address - Country:US
Mailing Address - Phone:240-997-4759
Mailing Address - Fax:
Practice Address - Street 1:1305 W 7TH ST STE 1
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4100
Practice Address - Country:US
Practice Address - Phone:301-834-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182654363LF0000X
MDR187518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily