Healthcare Provider Details

I. General information

NPI: 1417290271
Provider Name (Legal Business Name): JILL NICOLE MUSSULMAN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL NICOLE NEAL REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 03/30/2013
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG RD
BATTLE CREEK MI
49037-7314
US

IV. Provider business mailing address

5109 BROOKMEADOW CIR APT D
KALAMAZOO MI
49048-8292
US

V. Phone/Fax

Practice location:
  • Phone: 692-966-5600
  • Fax: 269-223-6501
Mailing address:
  • Phone: 269-569-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number4704230385
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: