Provider Demographics
NPI:1063042513
Name:GREER, JILLIAN ROSE (NP)
Entity type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:ROSE
Last Name:GREER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:JILLIAN
Other - Middle Name:ROSE
Other - Last Name:FINLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:10012 CALUMET AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-4055
Mailing Address - Country:US
Mailing Address - Phone:219-227-5119
Mailing Address - Fax:219-227-5190
Practice Address - Street 1:174 BRACKEN PKWY
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6789
Practice Address - Country:US
Practice Address - Phone:219-227-5119
Practice Address - Fax:219-227-5190
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009815A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300036268Medicaid