Provider Demographics
NPI:1023594413
Name:WEESE, JILL L (MSN, RN, CDE)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:WEESE
Suffix:
Gender:F
Credentials:MSN, RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MICHIGAN AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1530
Mailing Address - Country:US
Mailing Address - Phone:574-753-1339
Mailing Address - Fax:
Practice Address - Street 1:1201 MICHIGAN AVE STE 270
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1530
Practice Address - Country:US
Practice Address - Phone:574-753-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28186606A163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator