Provider Demographics
NPI:1700334737
Name:STILLER, JILL SUHY (ARNP-CNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUHY
Last Name:STILLER
Suffix:
Gender:F
Credentials:ARNP-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 SHEPHERDS LN
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-9707
Mailing Address - Country:US
Mailing Address - Phone:208-920-0285
Mailing Address - Fax:
Practice Address - Street 1:1215 MICHIGAN ST
Practice Address - Street 2:STE B
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5014
Practice Address - Country:US
Practice Address - Phone:208-265-2418
Practice Address - Fax:208-263-0583
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID54178363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily