Provider Demographics
NPI:1861762858
Name:KISMET, JILL ELIZABETH (LAC)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ELIZABETH
Last Name:KISMET
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5940 W UNION HILLS DR
Mailing Address - Street 2:SUITE D-250
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1308
Mailing Address - Country:US
Mailing Address - Phone:480-321-9336
Mailing Address - Fax:
Practice Address - Street 1:5940 W UNION HILLS DR
Practice Address - Street 2:SUITE D-250
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1308
Practice Address - Country:US
Practice Address - Phone:480-321-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0754171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist