Healthcare Provider Details

I. General information

NPI: 1063510949
Provider Name (Legal Business Name): JILL A. MILLER N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W WASHINGTON ST
PITTSFIELD IL
62363-1350
US

IV. Provider business mailing address

927 BROADWAY ST STE 121
QUINCY IL
62301-2727
US

V. Phone/Fax

Practice location:
  • Phone: 217-285-9447
  • Fax:
Mailing address:
  • Phone: 217-223-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number152949
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209000441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: