Provider Demographics
NPI:1366215964
Name:VICK, JILL R (MW)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:VICK
Suffix:
Gender:F
Credentials:MW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7904 WISE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3408
Mailing Address - Country:US
Mailing Address - Phone:513-254-1764
Mailing Address - Fax:
Practice Address - Street 1:7904 WISE AVE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3408
Practice Address - Country:US
Practice Address - Phone:513-254-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTCD000721374J00000X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula