Provider Demographics
NPI:1871668756
Name:SISSON, JILL AMORET (RN,NNP)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:AMORET
Last Name:SISSON
Suffix:
Gender:F
Credentials:RN,NNP
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:AMORET
Other - Last Name:CORLEY-BANGERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,NNP
Mailing Address - Street 1:7820 STATE ROUTE 4
Mailing Address - Street 2:
Mailing Address - City:WORDEN
Mailing Address - State:IL
Mailing Address - Zip Code:62097-2042
Mailing Address - Country:US
Mailing Address - Phone:618-633-2214
Mailing Address - Fax:
Practice Address - Street 1:10010 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-4859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO093032163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care