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General NPI Number Information
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NPI Number | 1649063199
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Entity Type | Individual
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Provider Name | JILL ANN WALL FNP
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Gender | Female
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 245 REGENCY CT
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City | BROOKFIELD
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State | WI
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Zip | 53045-6167
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Country | US
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Telephone | 262-357-6075
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Fax |
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Provider Business Mailing Address
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Address Line | W169N10790 REDWOOD LN
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City | GERMANTOWN
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State | WI
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Zip | 53022-3970
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Country | US
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Telephone | 414-345-8504
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 16839-33
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License Number State | WI
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