Provider Demographics
NPI:1255777983
Name:OBERT, JILL ELIZABETH (PA)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:ELIZABETH
Last Name:OBERT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 MALSBARY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5653
Mailing Address - Country:US
Mailing Address - Phone:513-791-1222
Mailing Address - Fax:513-791-2561
Practice Address - Street 1:4370 MALSBARY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5653
Practice Address - Country:US
Practice Address - Phone:513-791-1222
Practice Address - Fax:513-791-2561
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001471363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical