Provider Demographics
NPI:1396103529
Name:MARQUIS, JILL CHRISTEN (LPN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:CHRISTEN
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 W FIREWEED LN
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2562
Mailing Address - Country:US
Mailing Address - Phone:907-770-0862
Mailing Address - Fax:
Practice Address - Street 1:670 W FIREWEED LN
Practice Address - Street 2:SUITE 160
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2562
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK107650164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse