Healthcare Provider Details

I. General information

NPI: 1437638848
Provider Name (Legal Business Name): JILLIAN MARIE SINCLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN STE 100
DANVILLE IN
46122-1993
US

IV. Provider business mailing address

650 AUSTRIAN WAY
AVON IN
46123-7461
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-7310
  • Fax:
Mailing address:
  • Phone: 219-869-3590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008210A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: