Provider Demographics
NPI:1730157652
Name:POLMATEER, JILL NORENE (NP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:NORENE
Last Name:POLMATEER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 CASS ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3236
Mailing Address - Country:US
Mailing Address - Phone:231-941-1155
Mailing Address - Fax:231-941-1347
Practice Address - Street 1:1104 CASS ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-3236
Practice Address - Country:US
Practice Address - Phone:231-941-1155
Practice Address - Fax:231-941-1347
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704155176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008700740OtherBCBS
MI4163111Medicaid
MI4163111Medicaid
MI4163111Medicaid