Healthcare Provider Details

I. General information

NPI: 1306464797
Provider Name (Legal Business Name): JILL PATRICIA JUNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2020
Last Update Date: 07/11/2020
Certification Date: 07/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 NW 84TH AVE
ANKENY IA
50023-9443
US

IV. Provider business mailing address

2546 NW 84TH AVE
ANKENY IA
50023-9443
US

V. Phone/Fax

Practice location:
  • Phone: 515-707-5294
  • Fax:
Mailing address:
  • Phone: 515-707-5294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: