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General NPI Number Information
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NPI Number | 1760107742
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Entity Type | Individual
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Provider Name | JILL NEWBERG FNP
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Gender | Female
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 1 E COUNTY LINE RD STE B
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City | SANDWICH
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State | IL
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Zip | 60548-9574
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Country | US
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Telephone | 815-786-2722
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Fax |
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Provider Business Mailing Address
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Address Line | 903 DERBY DR
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City | PLANO
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State | IL
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Zip | 60545-2108
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Country | US
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Telephone | 630-636-0846
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.025927
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License Number State | IL
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