Provider Demographics
NPI:1699082552
Name:REESE, JILL ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANN
Last Name:REESE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 A AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5036
Mailing Address - Country:US
Mailing Address - Phone:319-369-8600
Mailing Address - Fax:319-369-7416
Practice Address - Street 1:1026 A AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5036
Practice Address - Country:US
Practice Address - Phone:319-369-8600
Practice Address - Fax:319-369-7419
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002382363A00000X
MO2010031396363A00000X
IL085.003956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA002382OtherIOWA PA LICENSE
IL567730019Medicare PIN
MO2010031396OtherLICENSE