Healthcare Provider Details

I. General information

NPI: 1992367825
Provider Name (Legal Business Name): JILL ANN TIEBOR-FRANZ RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 DAVIS RD
WEST FALLS NY
14170-9781
US

IV. Provider business mailing address

PO BOX 489
WEST FALLS NY
14170-0489
US

V. Phone/Fax

Practice location:
  • Phone: 716-655-8776
  • Fax: 716-655-7877
Mailing address:
  • Phone: 716-655-8776
  • Fax: 716-655-7877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number382410-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: