MEDICARE: JILLIAN RODNEY AGPCNP-BC

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	363L00000X	Nurse Practitioner	2015021434	MI

General Provider Information

NPI Number	:	1205295573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN RODNEY AGPCNP-BC

Provider Business Mailing Address
First Line	:	611 W BELLE AVE
Second Line	:
City	:	SAINT CHARLES
State	:	MI
Zip	:	48655-1611
Country	:	US
Telephone Number	:	989-865-9958
Fax Number	:	989-865-8099

Provider Business Practice Location Address
First Line	:	611 W BELLE AVE
Second Line	:
City	:	SAINT CHARLES
State	:	MI
Zip	:	48655-1611
Country	:	US
Telephone Number	:	989-865-9958
Fax Number	:	989-865-8099

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

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	02/07/2019

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