Provider Demographics
NPI:1841310182
Name:PROSE, JILL CLAUDETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:CLAUDETTE
Last Name:PROSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 W GROVERS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3006
Mailing Address - Country:US
Mailing Address - Phone:602-467-5310
Mailing Address - Fax:602-467-5380
Practice Address - Street 1:3910 W GROVERS AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3006
Practice Address - Country:US
Practice Address - Phone:602-467-5310
Practice Address - Fax:602-467-5380
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN035287163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool