MEDICARE: MRS. JILL ANN KELLY R.N.

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	163W00000X	Registered Nurse	71271-30	WI

General Provider Information

NPI Number	:	1992146625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL ANN KELLY R.N.

Provider Business Mailing Address
First Line	:	21600 W NORTH AVE
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4742
Country	:	US
Telephone Number	:	262-782-4344
Fax Number	:	262-782-7485

Provider Business Practice Location Address
First Line	:	21600 W NORTH AVE
Second Line	:
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4742
Country	:	US
Telephone Number	:	262-782-4344
Fax Number	:	262-782-7485

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

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	07/10/2013

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