Provider Demographics
NPI:1417290271
Name:MUSSULMAN, JILL NICOLE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:NICOLE
Last Name:MUSSULMAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:NICOLE
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:5109 BROOKMEADOW CIR APT D
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-8292
Mailing Address - Country:US
Mailing Address - Phone:269-569-1238
Mailing Address - Fax:
Practice Address - Street 1:5500 ARMSTRONG RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-7314
Practice Address - Country:US
Practice Address - Phone:692-966-5600
Practice Address - Fax:269-223-6501
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-30
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704230385163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology