Provider Demographics
NPI:1821052887
Name:NOLL, JILL NADENE (CNM)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:NADENE
Last Name:NOLL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22255 GREENFIELD RD STE 352
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3712
Mailing Address - Country:US
Mailing Address - Phone:248-849-3401
Mailing Address - Fax:248-849-4106
Practice Address - Street 1:22255 GREENFIELD RD STE 352
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3712
Practice Address - Country:US
Practice Address - Phone:248-849-3401
Practice Address - Fax:248-849-4106
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC173591163W00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704333101OtherNURSE SPECIALTY CERTIFICATION
NC267OtherMIDWIFE LICENSE