Basic Information
| Provider Information | |||||||||
| NPI: | 1750718904 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | METZLER | ||||||||
| FirstName: | JILL | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11128 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984110128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532728148 | ||||||||
| FaxNumber: | 2534040506 | ||||||||
| Practice Location | |||||||||
| Address1: | 8573 E PRINCESS DR | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852557819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805635757 | ||||||||
| FaxNumber: | 4805635851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2013 | ||||||||
| LastUpdateDate: | 04/10/2014 | ||||||||
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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 | 363L00000X | AP5235 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 5235 | 01 | AZ | AZ LICENSE | OTHER | Z102830 | 01 | AZ | MEDICARE PTAN GROUP | OTHER | Z162487 | 01 | AZ | MEDICARE PTAN | OTHER | 855650 | 05 | AZ | MEDICAID |