MEDICARE: MRS. JILL CONNER N.P.

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	363LF0000X	Family Nurse Practitioner	03563	LA

General Provider Information

NPI Number	:	1891824454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL CONNER N.P.

Provider Business Mailing Address
First Line	:	3635 NELSON ROAD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-0000
Country	:	US
Telephone Number	:	337-477-0011
Fax Number	:	337-477-0010

Provider Business Practice Location Address
First Line	:	3635 NELSON ROAD
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-0000
Country	:	US
Telephone Number	:	337-477-0011
Fax Number	:	337-477-0010

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	09/13/2007

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