Provider Demographics
NPI:1114255528
Name:BRUNS, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BRUNS
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 1:105 S 5TH ST
Mailing Address - Street 2:SUITE 119H
Mailing Address - City:OLIVIA
Mailing Address - State:MN
Mailing Address - Zip Code:56277-1374
Mailing Address - Country:US
Mailing Address - Phone:320-523-2570
Mailing Address - Fax:
Practice Address - Street 1:105 S 5TH ST
Practice Address - Street 2:SUITE 119H
Practice Address - City:OLIVIA
Practice Address - State:MN
Practice Address - Zip Code:56277-1374
Practice Address - Country:US
Practice Address - Phone:320-523-2570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR087317-2163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health