Provider Demographics
NPI:1295570844
Name:HEPNER, JILL (RDMS RDCS RVT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:HEPNER
Suffix:
Gender:F
Credentials:RDMS RDCS RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E AMA FILLE LN
Mailing Address - Street 2:
Mailing Address - City:ELK RIDGE
Mailing Address - State:UT
Mailing Address - Zip Code:84651-4516
Mailing Address - Country:US
Mailing Address - Phone:505-860-8060
Mailing Address - Fax:
Practice Address - Street 1:523 N SR 198
Practice Address - Street 2:SUITE 205
Practice Address - City:SALEM
Practice Address - State:UT
Practice Address - Zip Code:84653
Practice Address - Country:US
Practice Address - Phone:385-422-4715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1783492085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound