Provider Demographics
NPI:1659821635
Name:MCCOY, JILLIAN LEE
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:LEE
Last Name:MCCOY
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 1:3204 GRANT LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-5054
Mailing Address - Country:US
Mailing Address - Phone:989-930-4838
Mailing Address - Fax:989-930-4838
Practice Address - Street 1:3204 GRANT LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-5054
Practice Address - Country:US
Practice Address - Phone:989-930-4838
Practice Address - Fax:989-930-4838
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care