Healthcare Provider Details

I. General information

NPI: 1225876121
Provider Name (Legal Business Name): JILL MARIE ALDRICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E10775 PINE RD
FALL CREEK WI
54742-4533
US

IV. Provider business mailing address

E10775 PINE RD
FALL CREEK WI
54742-4533
US

V. Phone/Fax

Practice location:
  • Phone: 715-559-0798
  • Fax:
Mailing address:
  • Phone: 715-559-0798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number145192-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: