Basic Information
| Provider Information | |||||||||
| NPI: | 1700075058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRALLEY | ||||||||
| FirstName: | JILL | ||||||||
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| Credential: | RN, PHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 N SAN ANTONIO RD | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056815461 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2115 CENTERPOINTE PKWY | ||||||||
| Address2: | SANTA MARIA PUBLIC HEALTH CLINIC | ||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934551334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8053467230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2007 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | PHN# 53033 | CA | Y | Nursing Service Providers | Registered Nurse | Community Health | 163WC1500X | RN# 443334 | CA | N | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.