Provider Demographics
NPI:1871220780
Name:HALLAS, JILL NICOLE
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:NICOLE
Last Name:HALLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1158
Mailing Address - Country:US
Mailing Address - Phone:740-395-7182
Mailing Address - Fax:
Practice Address - Street 1:67 PARKVIEW AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1525
Practice Address - Country:US
Practice Address - Phone:740-286-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3747P1801XMedicaid