| Doctor Name: | JILL BALLANTINE |
| NPI Number: | 1073979555 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AGACNP |
| License Number: | H098201 |
| Business Practice Address: | 250 Mercy Dr Dubuque, IA - 520017320 |
| Business Phone Number: | 5635843226 |
| Business Fax Number: | 5635843227 |
| Mailing Address: | 1500 Associates Dr, DUBUQUE |
| State: | IA |
| Postal Code: | 520022201 |
| Phone Number: | 5635844100 |
| Fax Number: | 5635844110 |
| NPI Enumeration Date: | 01/13/2016 |
| NPI Last Update Date: | 01/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | H098201 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |