Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 28188396A | IN |
NPI | 1003230145 |
---|---|
Provider Name | Mrs. Jill Koors |
First Address | Greensburg, IN 47240-1487 |
Second Address | Greensburg, IN 47240-1487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2014 |
Last Update Date | 10/02/2014 |