Individual
KATHERINE JILLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2709 N MAYVIEW RD, RALEIGH, NC 27607-4140
(612) 237-6212
Mailing address
2709 N MAYVIEW RD, RALEIGH, NC 27607-4140
(612) 237-6212
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
361768
NC
163WP0200X
Pediatric Registered Nurse
169919-3
MN
363L00000X
Nurse Practitioner
Primary
271
MN
363L00000X
Nurse Practitioner
JILL-BUGG2
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H400210067
MEDICARE PTAN
MN
Enumeration date
07/21/2011
Last updated
02/07/2024
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