Healthcare Provider Details

I. General information

NPI: 1649882820
Provider Name (Legal Business Name): JILL D CONNELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL D SPEICHER MSN

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S MAIN ST STE 6
CHARLES CITY IA
50616-3444
US

IV. Provider business mailing address

507 SUNSET PL
CHARLES CITY IA
50616-1634
US

V. Phone/Fax

Practice location:
  • Phone: 641-228-5151
  • Fax: 641-228-2902
Mailing address:
  • Phone: 319-215-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA159256
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: