Healthcare Provider Details

I. General information

NPI: 1487783270
Provider Name (Legal Business Name): JILL RENEE SOBCZYK P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 RIDGE ST SUITE 201
COUNCIL BLUFFS IA
51503-4643
US

IV. Provider business mailing address

808 E PIERCE ST
COUNCIL BLUFFS IA
51503-4601
US

V. Phone/Fax

Practice location:
  • Phone: 712-322-5899
  • Fax: 712-322-5730
Mailing address:
  • Phone: 712-396-4340
  • Fax: 712-396-4180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001791
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: