Healthcare Provider Details

I. General information

NPI: 1831810639
Provider Name (Legal Business Name): JILLIAN ANNA KILREA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S MICHIGAN AVE APT 801
CHICAGO IL
60605-3268
US

IV. Provider business mailing address

1250 S MICHIGAN AVE APT 801
CHICAGO IL
60605-3268
US

V. Phone/Fax

Practice location:
  • Phone: 312-975-1922
  • Fax:
Mailing address:
  • Phone: 312-975-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number041.491867
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: