Provider Demographics
NPI:1295908259
Name:OBRIEN, JILL C (ANP-BC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:61054-1646
Mailing Address - Country:US
Mailing Address - Phone:815-734-6061
Mailing Address - Fax:815-734-9021
Practice Address - Street 1:102 S HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3013
Practice Address - Country:US
Practice Address - Phone:815-285-8520
Practice Address - Fax:815-285-8903
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004480363L00000X
IL209004480363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400458270OtherMEDICARE PTAN
IL$$$$$$$$$001Medicaid