MEDICARE: JILL M FREEMYER CNP

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	R62168	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM006J93	OTHER	NM	BCBS OF NM

General Provider Information

NPI Number	:	1437348208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL M FREEMYER CNP

Provider Business Mailing Address
First Line	:	3005 HILLRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4703
Country	:	US
Telephone Number	:	575-525-3980
Fax Number	:	575-523-8660

Provider Business Practice Location Address
First Line	:	3005 HILLRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4703
Country	:	US
Telephone Number	:	575-525-3980
Fax Number	:	575-523-8660

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

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	02/01/2024

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