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Individual
JILL T DEFIBAUGH
Active
Individual
JILL T DEFIBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024166690
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001788730
MOUNTAIN STATE BCBS
VA
05
—
010211417
—
VA
01
—
289215
ANTHEM BCBS
VA
05
—
3810003821
—
WV
Enumeration date
01/19/2006
Last updated
07/29/2010
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