Individual
JILL E MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1931 INDUSTRIAL PARK RD, CONWAY, SC 29526-5645
(843) 915-8768
Mailing address
1931 INDUSTRIAL PARK RD, CONWAY, SC 29526-5645
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
3684
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100500023
MEDICAID GROUP
NV
05
—
2402636
—
NV
05
—
3102636
—
NV
01
—
VWCHKL
MEDICARE GROUP
NV
Enumeration date
01/31/2006
Last updated
10/11/2010
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