Provider Demographics
NPI:1356762272
Name:JOSEPH, JILL (RN)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 LOMAS BLVD NE
Mailing Address - Street 2:#37
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5909
Mailing Address - Country:US
Mailing Address - Phone:505-712-2997
Mailing Address - Fax:
Practice Address - Street 1:12601 LOMAS BLVD NE
Practice Address - Street 2:#37
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5909
Practice Address - Country:US
Practice Address - Phone:505-712-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR28865163W00000X
PARN235758L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse