Individual
JILL MARIE FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 457-3065
(618) 351-6476
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209022604
IL
363L00000X
Nurse Practitioner
Primary
277004870
IL
Other
Enumeration date
06/30/2021
Last updated
05/05/2026
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