Provider Demographics
NPI:1538893474
Name:SHUTTS, JILL (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SHUTTS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9574 STATE ROUTE 550
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784-5523
Mailing Address - Country:US
Mailing Address - Phone:740-336-0497
Mailing Address - Fax:
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-374-1627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.323178163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant