Healthcare Provider Details

I. General information

NPI: 1154760825
Provider Name (Legal Business Name): JILL LEANN EMERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOMESTEAD AVE
WHEELING WV
26003-6638
US

IV. Provider business mailing address

24 HOMESTEAD AVE
WHEELING WV
26003-6638
US

V. Phone/Fax

Practice location:
  • Phone: 304-232-1020
  • Fax: 740-232-1209
Mailing address:
  • Phone: 304-232-1020
  • Fax: 740-232-1209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number70768
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: