Healthcare Provider Details

I. General information

NPI: 1780207308
Provider Name (Legal Business Name): JILL D GILLESPIE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E PALATINE RD
PALATINE IL
60074-5551
US

IV. Provider business mailing address

874 PRAIRIE LILY LN
DAVIS JUNCTION IL
61020-9450
US

V. Phone/Fax

Practice location:
  • Phone: 847-776-1400
  • Fax:
Mailing address:
  • Phone: 630-738-1801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016752
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: