Provider Demographics
NPI:1689249641
Name:SCOTT, JILLIAN COHREN (FNP-C)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:COHREN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:
Other - Last Name:DIEKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1030 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3113
Mailing Address - Country:US
Mailing Address - Phone:734-682-3309
Mailing Address - Fax:734-682-1488
Practice Address - Street 1:1030 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3113
Practice Address - Country:US
Practice Address - Phone:734-682-3309
Practice Address - Fax:734-682-1488
Is Sole Proprietor?:No
Enumeration Date:2021-05-23
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704325307363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner