Healthcare Provider Details

I. General information

NPI: 1225018914
Provider Name (Legal Business Name): JILL T DEFIBAUGH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 VALLEY AVE SUITE 200
WINCHESTER VA
22601-2676
US

IV. Provider business mailing address

2913 VALLEY AVE SUITE 200
WINCHESTER VA
22601-2676
US

V. Phone/Fax

Practice location:
  • Phone: 540-678-0792
  • Fax: 540-678-0795
Mailing address:
  • Phone: 540-678-0792
  • Fax: 540-678-0795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024166690
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: