Provider Demographics
NPI:1689812034
Name:EMERSON, JILL MARIE (CNA II)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MARIE
Last Name:EMERSON
Suffix:
Gender:F
Credentials:CNA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 DUBOIS DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6041
Mailing Address - Country:US
Mailing Address - Phone:360-798-2420
Mailing Address - Fax:
Practice Address - Street 1:4605 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6041
Practice Address - Country:US
Practice Address - Phone:360-798-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200710022CNA376K00000X
WANC10089902376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide