Provider Demographics
NPI:1770666281
Name:THILL, JENNIFER KRISTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KRISTIN
Last Name:THILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9578
Mailing Address - Country:US
Mailing Address - Phone:509-826-1760
Mailing Address - Fax:509-826-7211
Practice Address - Street 1:810 JASMINE ST
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9578
Practice Address - Country:US
Practice Address - Phone:509-826-1760
Practice Address - Fax:509-826-7211
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0222348OtherL&I
WA8944672OtherCV
WA8484529Medicaid
WA8944672OtherCV
WA8484529Medicaid