Provider Demographics
NPI:1063696979
Name:ANDERSON, JILL (APRN, MSN, CCNS)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN, MSN, CCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 W. CURTISIAN AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-0107
Mailing Address - Country:US
Mailing Address - Phone:208-367-4278
Mailing Address - Fax:
Practice Address - Street 1:6140 W. CURTISIAN AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-0107
Practice Address - Country:US
Practice Address - Phone:208-367-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNS27163WC3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation