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General NPI Number Information
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NPI Number | 1477955201
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Entity Type | Individual
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Provider Name | JILL VAN THOLEN
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Gender | Female
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 9495 KEILMAN ST STE 6
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City | SAINT JOHN
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State | IN
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Zip | 46373-9295
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Country | US
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Telephone | 219-440-1232
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Fax | 219-285-5687
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Provider Business Mailing Address
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Address Line | 9495 KEILMAN ST STE 6
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City | SAINT JOHN
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State | IN
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Zip | 46373-9295
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Country | US
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Telephone | 219-440-1232
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Fax | 219-285-5687
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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 | 71005137A
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License Number State | IN
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