Provider Demographics
NPI:1164814604
Name:HEUER, JILL RENEE
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:RENEE
Last Name:HEUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:RENEE
Other - Last Name:HUFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4689 SHORELINE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRING PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55384-9715
Mailing Address - Country:US
Mailing Address - Phone:952-471-3784
Mailing Address - Fax:
Practice Address - Street 1:4689 SHORELINE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRING PARK
Practice Address - State:MN
Practice Address - Zip Code:55384-9715
Practice Address - Country:US
Practice Address - Phone:952-471-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist