Healthcare Provider Details

I. General information

NPI: 1033617550
Provider Name (Legal Business Name): JEANNE GILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E 29TH ST
SOUTH SIOUX CITY NE
68776-3344
US

IV. Provider business mailing address

PO BOX 83
JACKSON NE
68743-0083
US

V. Phone/Fax

Practice location:
  • Phone: 402-494-1662
  • Fax: 402-494-1662
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number55726
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number55726
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: