Provider Demographics
NPI:1063892073
Name:BUTTOLPH, JILL LYNN (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LYNN
Last Name:BUTTOLPH
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:LYNN
Other - Last Name:SIMMERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-2609
Mailing Address - Country:US
Mailing Address - Phone:216-538-5164
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-2609
Practice Address - Country:US
Practice Address - Phone:216-538-5164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.319031363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.17738OtherAPRN
OH2015002406OtherANCC- AGACNP
OHMB7491789OtherDEA