MEDICARE: MS. JILL E KLOTZBACH N.P.

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	276142-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881687127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL E KLOTZBACH N.P.

Provider Business Mailing Address
First Line	:	24 RICHMOND AVE
Second Line	:
City	:	BATAVIA
State	:	NY
Zip	:	14020-1421
Country	:	US
Telephone Number	:	585-798-1053
Fax Number	:	585-798-5639

Provider Business Practice Location Address
First Line	:	11075 W CENTER STREET EXT
Second Line	:
City	:	MEDINA
State	:	NY
Zip	:	14103-9557
Country	:	US
Telephone Number	:	585-798-1053
Fax Number	:	585-798-5639

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/09/2010

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