MEDICARE: JILL MARIE CRUMLEY NNP

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	363LN0000X	Neonatal Nurse Practitioner	516462	TX

General Provider Information

NPI Number	:	1811227945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL MARIE CRUMLEY NNP

Provider Business Mailing Address
First Line	:	7567 SAINT STEPHENS SQ
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-3125
Country	:	US
Telephone Number	:	214-908-9102
Fax Number	:

Provider Business Practice Location Address
First Line	:	7567 SAINT STEPHENS SQ
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75035-3125
Country	:	US
Telephone Number	:	214-908-9102
Fax Number	:

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

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	03/28/2013

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