Provider Demographics
NPI:1760107742
Name:NEWBERG, JILL (FNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:NEWBERG
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 1:903 DERBY DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:IL
Mailing Address - Zip Code:60545-2108
Mailing Address - Country:US
Mailing Address - Phone:630-636-0846
Mailing Address - Fax:
Practice Address - Street 1:1 E COUNTY LINE RD STE B
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-9574
Practice Address - Country:US
Practice Address - Phone:815-786-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner