Provider Demographics
NPI:1053392837
Name:MCEACHERN, JILL (ARNP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MCEACHERN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 BOSTON POST RD
Mailing Address - Street 2:UNIT 6C
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-9994
Mailing Address - Country:US
Mailing Address - Phone:475-308-8619
Mailing Address - Fax:
Practice Address - Street 1:705 BOSTON POST RD
Practice Address - Street 2:UNIT 6C
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-9994
Practice Address - Country:US
Practice Address - Phone:475-308-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005373207VG0400X
WARN00127171207VG0400X
CT4630363LA2200X, 363LW0102X
CT004630363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP60084Medicare UPIN