Provider Demographics
NPI:1659512077
Name:WILEY, JILL RACQUEL (RN)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:RACQUEL
Last Name:WILEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13712 VIOLET MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8155
Mailing Address - Country:US
Mailing Address - Phone:740-927-1447
Mailing Address - Fax:
Practice Address - Street 1:13712 VIOLET MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8155
Practice Address - Country:US
Practice Address - Phone:740-927-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-14
Last Update Date:2009-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH269206163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse