Healthcare Provider Details

I. General information

NPI: 1750718904
Provider Name (Legal Business Name): JILL METZLER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8573 E PRINCESS DR SUITE 215
SCOTTSDALE AZ
85255-7819
US

IV. Provider business mailing address

PO BOX 11128
TACOMA WA
98411-0128
US

V. Phone/Fax

Practice location:
  • Phone: 480-563-5757
  • Fax: 480-563-5851
Mailing address:
  • Phone: 253-272-8148
  • Fax: 253-404-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP5235
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: