MEDICARE: MRS. JILL DUTSON ANDERSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA1696	NV

General Provider Information

NPI Number	:	1336505163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL DUTSON ANDERSON PA-C

Provider Business Mailing Address
First Line	:	6813 PAINTED MORNING AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-3645
Country	:	US
Telephone Number	:	702-630-8831
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 MARINER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-6656
Country	:	US
Telephone Number	:	702-228-9066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2016
Last Update Date	:	04/24/2018

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