Basic Information
| Provider Information | |||||||||
| NPI: | 1023591807 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDANIEL | ||||||||
| FirstName: | JILL | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 SURRY DR | ||||||||
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| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274086819 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1126 N CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274011000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369380800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2018 | ||||||||
| LastUpdateDate: | 08/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 5010751 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.