Provider Demographics
NPI:1942468863
Name:OLIVER, JILL I (APRN)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:I
Last Name:OLIVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:703 PRO MED LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5317
Practice Address - Country:US
Practice Address - Phone:317-843-9922
Practice Address - Fax:317-581-3918
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002894A364S00000X, 364SP0808X
IN28133216A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000891415OtherANTHEM
IN000000890557OtherANTHEM
IN000000889739OtherANTHEM
IN266180398Medicare PIN
IN000000889739OtherANTHEM
IN000000890557OtherANTHEM