Provider Demographics
NPI:1619620267
Name:ORTH, JILLIAN RAE (FNP)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RAE
Last Name:ORTH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:CULBERTSON
Mailing Address - State:MT
Mailing Address - Zip Code:59218-0794
Mailing Address - Country:US
Mailing Address - Phone:406-949-1423
Mailing Address - Fax:
Practice Address - Street 1:221 UNIVERSITY AVE STE 102
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5618
Practice Address - Country:US
Practice Address - Phone:701-609-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR51785363LF0000X
MTNUR-APRN-LIC-198482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily