Healthcare Provider Details

I. General information

NPI: 1336212042
Provider Name (Legal Business Name): JILL ALISON PLICHTA ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 S EAST ST STE H
INDIANAPOLIS IN
46227-1939
US

IV. Provider business mailing address

120 W 22ND ST STE 200
OAK BROOK IL
60523-1563
US

V. Phone/Fax

Practice location:
  • Phone: 317-924-8425
  • Fax: 317-924-8424
Mailing address:
  • Phone: 630-573-5000
  • Fax: 317-924-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number71002259A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: