=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700334737
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL SUHY STILLER ARNP-CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2016
-----------------------------------------------------
Last Update Date | 09/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1215 MICHIGAN ST STE B
-----------------------------------------------------
City | SANDPOINT
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83864-5014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-265-2418
-----------------------------------------------------
Fax | 208-263-0583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 902 SHEPHERDS LN
-----------------------------------------------------
City | SANDPOINT
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83864-9707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-920-0285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 54178
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------