Healthcare Provider Details

I. General information

NPI: 1851734685
Provider Name (Legal Business Name): JILL E ONEILL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL E WIMBERLY CRNA

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3138
  • Fax:
Mailing address:
  • Phone: 312-942-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041341103
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28542
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: