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General NPI Number Information
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NPI Number | 1295908259
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Entity Type | Individual
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Provider Name | JILL C OBRIEN ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 102 S HENNEPIN AVE
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City | DIXON
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State | IL
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Zip | 61021-3013
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Country | US
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Telephone | 815-285-8520
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Fax | 815-285-8903
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Provider Business Mailing Address
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Address Line | 405 CHARLES ST
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City | MOUNT MORRIS
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State | IL
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Zip | 61054-1646
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Country | US
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Telephone | 815-734-6061
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Fax | 815-734-9021
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209-004480
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209004480
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License Number State | IL
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