Individual
JILL FORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
200 HILLMONT AVE, VENTURA, CA 93003-1647
(805) 652-5755
Mailing address
PO BOX 24249, VENTURA, CA 93002-4249
(805) 652-5755
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
388306
CA
Other
Enumeration date
07/03/2008
Last updated
07/03/2008
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