Provider Demographics
NPI:1528338811
Name:MENNEMEIER, JILL (BSN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MENNEMEIER
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:602 S LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-4787
Mailing Address - Country:US
Mailing Address - Phone:334-293-7157
Mailing Address - Fax:334-293-7374
Practice Address - Street 1:602 S LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-4787
Practice Address - Country:US
Practice Address - Phone:334-293-7157
Practice Address - Fax:334-293-7374
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-093180163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse