1063042513 NPI number — MISS JILLIAN ROSE GREER NP

Table of content: MISS JILLIAN ROSE GREER NP (NPI 1063042513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063042513 NPI number — MISS JILLIAN ROSE GREER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREER
Provider First Name:
JILLIAN
Provider Middle Name:
ROSE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FINLEY
Provider Other First Name:
JILLIAN
Provider Other Middle Name:
ROSE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1063042513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10012 CALUMET AVE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
MUNSTER
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46321-4055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-227-5119
Provider Business Mailing Address Fax Number:
219-227-5190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
174 BRACKEN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOBART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46342-6789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-227-5119
Provider Business Practice Location Address Fax Number:
219-227-5190
Provider Enumeration Date:
01/23/2020

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: 363LF0000X , with the licence number:  71009815A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300036268 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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