1720099773 NPI number — JILL LITWILLER APRN

Table of content: JILL LITWILLER APRN (NPI 1720099773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720099773 NPI number — JILL LITWILLER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITWILLER
Provider First Name:
JILL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRANDT
Provider Other First Name:
JILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720099773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67114-8778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-283-6103
Provider Business Mailing Address Fax Number:
316-284-5082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67114-8778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-283-3600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  44368 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6678 . This is a "PHS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 161045 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 30004392120005 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100356420A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".