Provider Demographics
NPI:1790757243
Name:DILL, JEAN E (APNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:DILL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1844
Mailing Address - Country:US
Mailing Address - Phone:920-730-5470
Mailing Address - Fax:
Practice Address - Street 1:1611 S MADISON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1844
Practice Address - Country:US
Practice Address - Phone:920-730-5470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2388033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41177600Medicaid
WI0510 45300Medicare PIN
WI0510 71018Medicare PIN