Provider Demographics
NPI:1952950719
Name:LANDRY, JILL MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:LANDRY
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 1:655 ISRAEL RD SW APT D
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5471
Mailing Address - Country:US
Mailing Address - Phone:360-603-2459
Mailing Address - Fax:
Practice Address - Street 1:655 ISRAEL RD SW APT D
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5471
Practice Address - Country:US
Practice Address - Phone:360-603-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60578220163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse