Healthcare Provider Details

I. General information

NPI: 1063685279
Provider Name (Legal Business Name): JILL KRISTINE MONROE RN RCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CITY CTR
OSHKOSH WI
54901-4830
US

IV. Provider business mailing address

2122 HICKORY LANE
OSHKOSH WI
54901-2516
US

V. Phone/Fax

Practice location:
  • Phone: 920-456-3200
  • Fax:
Mailing address:
  • Phone: 920-379-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number111096030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number111096-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: