MEDICARE: JILL ALEXANDRA SHEPHERD APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209010189	IL

General Provider Information

NPI Number	:	1073853354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL ALEXANDRA SHEPHERD APN

Provider Business Mailing Address
First Line	:	161 WASHINGTON STREET, 14TH FLOOR
Second Line	:	EIGHT TOWER BRIDGE, SUITE 1400
City	:	CONSHOHOCKEN
State	:	PA
Zip	:	19428
Country	:	US
Telephone Number	:	866-825-3227
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 W ARMY TRAIL RD STE 104
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-1478
Country	:	US
Telephone Number	:	630-599-5400
Fax Number	:	630-705-1049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2013
Last Update Date	:	05/27/2021

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