Provider Demographics
NPI:1740008937
Name:SALO, JILLIAN COLLINS
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:COLLINS
Last Name:SALO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20320 S MACKINAC TRL
Mailing Address - Street 2:
Mailing Address - City:RUDYARD
Mailing Address - State:MI
Mailing Address - Zip Code:49780-9306
Mailing Address - Country:US
Mailing Address - Phone:906-322-2091
Mailing Address - Fax:
Practice Address - Street 1:740 S MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-2220
Practice Address - Country:US
Practice Address - Phone:231-627-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704364388NSA240UF363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily